Is the address that is written on the ticket your correct MAILING address?*
Select One
YES, Address on Ticket Correct
NO, Address On Ticket Not Correct
Phone and Email
TICKET INFORMATION
What type of Ticket did you receive:
Select One
Speeding Ticket
No Proof Of Insurance
Stop Sign
Electric Signal Violation
Allowing Unlicensed Driver
Assault
Careless Driving
Child Restraint Violation
Closed Road Way
Construction Zone Violation
Defective Brake Lights
Driving While Revoked
Driving While Suspended
Failure To Maintain Single Lane
Fake License/Altered Plates
Following To Close
Illegal Turn
Minor In Possession
No Driver License
No Headlights
No Operators License
No Plates
Paraphernalia
Possession Less Than 35 Grams
Racing
Speeding School Zone
Speed To Fast For Conditions
Theft
Using Park Lot Avoid Intersection
Wrong Way or Wrong Side of Street
Window Tint
Other
Did you receive a second ticket?
Select One
Speeding Ticket
No Proof Of Insurance
Stop Sign
Electric Signal Violation
Allowing Unlicensed Driver
Assault
Careless Driving
Child Restraint Violation
Closed Road Way
Construction Zone Violation
Defective Brake Lights
Driving While Revoked
Driving While Suspended
Failure To Maintain Single Lane
Fake License/Altered Plates
Following To Close
Illegal Turn
Minor In Possession
No Driver License
No Headlights
No Operators License
No Plates
Paraphernalia
Possession Less Than 35 Grams
Racing
Speeding School Zone
Speed To Fast For Conditions
Theft
Using Park Lot Avoid Intersection
Wrong Way or Wrong Side of Street
Window Tint
Other
Work Zone*?
Select One
No
Yes, but everyone is paid
Yes, Matter still pending
School Zone*?
Select One
No
Yes, but everyone is paid
Yes, Matter still pending
Did This Involve an Accident*?
Select One
No
Yes, but everyone is paid
Yes, Matter still pending
Information About The Court or Police Department
Court or Police Department that gave you the ticket: (Look at the top left-hand corner of ticket to find court name)
Court adddress: (This is usually found in the bottom right-hand portion of the ticket)
If there is a court date & time written on your ticket what are they?
Issue Date Written on the Ticket
Information About Your Driving Record
Any tickets in the last 12 months?
Currently on Probation for other offenses?
License Currently Suspended or Revoked?
Do you have any charges NOW PENDING in this or any other court?
I would prefer you contact me at:
