Traffic Intake Form

Please fill out the form with your information.

Thank you for completing the intake form. We will contact you soon.

Please complete all required fields below.

If you are a human, ignore this field

• Name *
• If you were charged under a different name, please indicate.
• Phone *
• Email *
• Mailing Address *
• Date of Birth *
• Driver License Number *
• Driver License State *
• Driver License Issue Date
• SSN
• County where charged
• Charge(s)
• Court Date
• Do you need a continuance? * No Yes
• Which reduction are you seeking?
• Any other info you want to tell us?