Wufoo

Name * First Last
Please make sure that your name is spelt correctly.
Email

If you have an email address, please provide it here.
Phone Number * ### - ### - ####
Please only provide the best possible phone number where we can reach you. If you have additional numbers, provide under additional information box below.
DATE OF BIRTH *

You date of birth is required in order to ensure that we are representing the right client.
TEXAS DRIVERS LICENSE / ID #: *

Please provide your Texas Drivers license # or State ID#
COURT ISSUING TICKET:

If you know the name of the Court, please provide it here. If you do not have this information, please leave blank. If you have tickets from two or more courts, please provide this information in the additional information box below.
CITATION Nos (IF KNOWN):

if you know the citation nos and or case numbers please provide it here. please leave blank if you do not have this information. If you have additional citations please provide them in the additional information box below.
PLEASE CHECK ALL THAT IS APPLICABLE TO YOU
IS TICKET PAST DUE? DID YOU FAIL TO APPEAR IN COURT? IS YOUR CITATION IN WARRANT STATUS? IS THERE A HOLD ON YOUR DRIVERS LICENSE? HAVE YOU APPEARED IN COURT BEFORE ON THIS CASE?

Please only check the boxes that are applicable to your situation. If none of the boxes are applicable to you, leave all blank or if you are not sure of what to answer, just leave it blank.
ADDITIONAL INFORMATION:

This is where you provide additional information about other tickets, citations, courts, counties and warrants or any other information that you have for us.
Do Not Fill This Out

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