Traffic Ticket Intake Form

Please fill out and submit the form below so we can assist you with your case as soon as possible. Upon submission of this form, we will send you a New Citation Packet by email with instructions for completion so that you do not need to visit our office. In the alternative, we will contact you via phone or email. Please feel free to call us at 817.877.3355 with any questions.

PERSONAL INFORMATON

Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country

###
###
####

###
###
####

###
###
####

MM/DD/YYYY
I have a valid driver's licenseI do not have a valid driver's license
Yes, I have a commercial licenseNo, I do not have a commercial license
YesNo
YesNo

Please complete as much information as possible for each ticket
TICKET #1 INFORMATION
MM/DD/YYYY
MM/DD/YYYY
YesNoUnsure

For example:
Offense (1): Speeding
Offense (2): No insurance
Offense (3): No inspection

N/AYesNo

TICKET #2 INFORMATION
MM/DD/YYYY
MM/DD/YYYY
YesNoUnsure

For example:
Offense (1): Speeding
Offense (2): No insurance
Offense (3): No inspection

N/AYesNo

TICKET #3 INFORMATION
MM/DD/YYYY
MM/DD/YYYY
YesNoUnsure

For example:
Offense (1): Speeding
Offense (2): No insurance
Offense (3): No inspection

N/AYesNo

TICKET #4 INFORMATION
MM/DD/YYYY
MM/DD/YYYY
YesNoUnsure

For example:
Offense (1): Speeding
Offense (2): No insurance
Offense (3): No inspection

N/AYesNo

DISCLAIMER: The contents of this contact form are being provided so that Hawkins & Walker, PC can evaluate your case. Upon evaluation, Hawkins & Walker, PC may send a new client contact, which contains a formal representation agreement and instructions for payment. This form does not create an attorney-client relationship and will not necessarily be treated as privileged or confidential. An attorney-client relationship will only be created upon your acknowledgment of the terms contained in the Municipal Citation Retainer Agreement and payment of applicable attorneys’ fees.
I confirm that I have read and foregoing disclaimer