Get Started Today.

Please fill out the fields below, or download our Client Intake Form.

Full Name *
Full Name
Address
Address
Home Phone *
Home Phone
Alternate Phone
Alternate Phone
Please indicate the State in which your License was issued.
Please include for how long.
If married, please include number of years married. If you have children, please list ages.
Please include the following: Full Name Full Address Primary Phone/Alternate phone Relationship
Please include the following: Full Name Telephone Relationship
Please include the following: Full Name Telephone Relationship
Charge(s):
Please include county.
If so, please include the following: What was the previous court date? When is the next court date?
Custody Status:
Date of incident:
If so, name(s) of all persons arrested:
Arresting Officer:
Name & county of probation/parole officer?
Driving Under the Influence Cases ONLY
If yes, date of hearing:
If yes, B.A.C? Breath or Blood test?
If yes, year & county?
If yes, ages/relationship to you?