704-470-2440

704-470-2440

Traffic Intake Form

Please fill out the form with your information.

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? *
Which reduction are you seeking?
Any other info you want to tell us?

Awards

303 West Marion Street
Shelby, NC 28150

704.754.8401 (fax)

Gastonia Office

316 S Chester St
Gastonia, NC 28052

704.754.8401 (fax)

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