TRAFFIC TICKET INTAKE FORM

Please complete the Traffic Ticket Intake form below and a representative from our office will call you to finalize hiring our firm to handle your traffic ticket(s).
Personal Information
Name *
Name
Date of Birth *
Date of Birth
Address *
Address
Phone *
Phone
Do you have a valid driver's license?
Do you have a commercial driver’s license?
Employer Address
Employer Address
Employer Phone
Employer Phone
Emergency Contacts
1. Name *
1. Name
1. Phone *
1. Phone
2. Name *
2. Name
2. Phone *
2. Phone
Ticket Information
Is your ticket past due or in warrant status?
Have you taken a Defensive Driving course in the past twelve (12) months?
Do you have insurance coverage?
Terms and Conditions
Client understands that it can take up to seven (7) business days for a warrant to be lifted depending on the court in which the warrant is located. Client consents to the association of counsel. I authorize the Attorney, or Associated Counsel, to sign my name to any documents necessary in my representation. I authorize the Attorney, or Associated Counsel, to plea my case(s) if I am not present in court. Client agrees to pay any fines, court costs, and expenses which may be assessed or charged in the above case(s). I understand that if any fines or court costs assessed in the above case(s) are not paid by me, a warrant will be issued for my arrest. Client agrees to contact the Attorney immediately if any of the above contact information changes. Failure to contact the Attorney of any changes in contact information may result in warrants being issued. If Client violates any of the contractual terms, or pursues unlawful activity, the Attorney may withdraw. “I hereby designate the Attorney, and Associated Counsel, listed in this contract as my true and lawful attorney, in fact as well as in law, and authorize him to sign my name to any appearance bond, or other legal document, and to acknowledge same before a Notary Public, as fully as if I signed myself. Additionally, I further authorize the attorney, or their representative, to appear in court on my behalf in the case wherein I am charged, or may be charged, as a result of my arrest, and to enter a plea of either “guilty” or “not guilty” on my behalf, as he may see fit; and he has express authority to bind me fully, as if I were present in court myself, and he may file any motions that he may see fit to file on my behalf. I further give him express authorit y to waive my appearance at any proceeding with reference to this case and to appear on my behalf. I further waive any right to jury trial and will give the attorney express authority to enter a plea on my behalf, even if that plea negatively affects my license, liberty or pecuniary interests.” *
I understand the following: A conviction or Deferred Disposition may have immigration consequences; A plea of “guilty” or “no contest” may result in deportation; Immigration Law is a specialized field of law, and this Attorney is not an Immigration Lawyer; I should consult an Immigration Attorney if I want advice on this subject. *
I waive my right to a trial and request my attorney to obtain the best plea bargain agreement he can obtain on my above case(s). I agree to pay the fee(s), or charge(s), assessed within the time allowed. I understand I must be present in court or risk convictions on my record. *
I agree to deliver to my Attorney any proof (e.g., current insurance and insurance at time of offense, inspection, registration) or evidence, to aid in the management of my case, within 24 hours of signing this contract. Failure to comply may result in a plea bargain agreement, wherein I may be found guilty or granted deferred disposition, and a fine assessed. *
I agree to be notified by EMAIL/MAIL/ OR TELEPHONE for all court settings and court results given to the Attorney. Please check one way you would like to get notified: *
I agree to pay any defer fees, court costs, and other fines including taking defensive driving if ordered by the court. If defensive driving is required, I am responsible to schedule classes and follow up with the order of the court. *
I AGREE IN THE EVENT MY TICKETS ARE IN CAPIAS WARRANT STATUS , THE WARD LAW GROUP SHALL RETAIN $50 PER CITATION AS AN INVESTIGATION FEE, AND NOTIFY ME THE AMOUNTS DUE. *