Test Form | Hawkins Walker, PC

Your Information

Name*

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Last

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Phone*

Mobile

Home

Work

Alternate

Email*

Primary

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Address*

Street

City*

City

State*

State

Zip*

Zip Code

Date of Birth*

Last 4 of your Social Security No.

(required to look you up in DPS's website)

Driver's License Information

Driver's license status:*

Do you have a commercial driver's license (CDL)?*

Driver's License Number

Issuing State

Upload Photo or PDF of License

Ticket Information

Court Name / Location*

Please state the court name and address:*

Citation Number*

Issuance Date (if known)

Appearance Date (if known)

Is this ticket in warrant?*

Yes
No
Unsure

Was there an accident?*

Yes
No

Do you have the ticket?*

Yes
No

Upload Photo or PDF of Ticket

(optional but helpful)

Select your violations (click all that apply)*

Other / Not Listed Violations*

Please list all violations separated by a comma

CMV Violations*

Please list all violations separated by a comma

Did you have valid insurance at the time of the violation?*

Yes
No

Do you have insurance now (with your name on the policy)?*

Yes
No

Upload photo or PDF of insurance

Has the registration on the vehicle you were driving been renewed?*

Yes
No

Upload Photo or PDF of Registration

RE REGISTRATION TICKETS: If you have not renewed the registration on the vehicle you were driving, renewing the registration may help get the ticket reduced or dismissed. When the registration is renewed, let the tax accessor know a citation was issued and pay the penalty fee.

RE SPEEDING TICKETS: Please be aware probation may not be available for speeds in excess of 30 mph over the posted limit, speeding greater than 15 mph in a school zone, speeding greater than 50% of the posted limit, or speeding in a construction zone with workers present.

Comments or Questions for this ticket that you want the attorney to know:

Do you have another ticket?*

Yes
No

Ticket 2 Information

Court Name / Location*

Please state the court name and address:*

Citation Number*

Issuance Date (if known)

Appearance Date (if known)

Is this ticket in warrant?*

Yes
No
Unsure

Was there an accident?*

Yes
No

Do you have the ticket?*

Yes
No

Upload Photo or PDF of Ticket

(optional but helpful)

Select your violations (click all that apply)*

Other / Not Listed Violations*

Please list all violations separated by a comma

CMV Violations*

Please list all violations separated by a comma

Did you have valid insurance at the time of the violation?*

Yes
No

Do you have insurance now (with your name on the policy)?*

Yes
No

Upload photo or PDF of insurance

Has the registration on the vehicle you were driving been renewed?*

Yes
No

Upload Photo or PDF of Registration

RE REGISTRATION TICKETS: If you have not renewed the registration on the vehicle you were driving, renewing the registration may help get the ticket reduced or dismissed. When the registration is renewed, let the tax accessor know a citation was issued and pay the penalty fee.

RE SPEEDING TICKETS: Please be aware probation may not be available for speeds in excess of 30 mph over the posted limit, speeding greater than 15 mph in a school zone, speeding greater than 50% of the posted limit, or speeding in a construction zone with workers present.

Comments or Questions for this ticket that you want the attorney to know:

Do you have another ticket?*

Yes
No

Ticket 3 Information

Court Name / Location*

Please state the court name and address:*

Citation Number*

Issuance Date (if known)

Appearance Date (if known)

Is this ticket in warrant?*

Yes
No
Unsure

Was there an accident?*

Yes
No

Do you have the ticket?*

Yes
No

Upload Photo or PDF of Ticket

(optional but helpful)

Select your violations (click all that apply)*

Other / Not Listed Violations*

Please list all violations separated by a comma

CMV Violations*

Please list all violations separated by a comma

Did you have valid insurance at the time of the violation?*

Yes
No

Do you have insurance now (with your name on the policy)?*

Yes
No

Upload photo or PDF of insurance

Has the registration on the vehicle you were driving been renewed?*

Yes
No

Upload Photo or PDF of Registration

RE REGISTRATION TICKETS: If you have not renewed the registration on the vehicle you were driving, renewing the registration may help get the ticket reduced or dismissed. When the registration is renewed, let the tax accessor know a citation was issued and pay the penalty fee.

RE SPEEDING TICKETS: Please be aware probation may not be available for speeds in excess of 30 mph over the posted limit, speeding greater than 15 mph in a school zone, speeding greater than 50% of the posted limit, or speeding in a construction zone with workers present.

Comments or Questions for this ticket that you want the attorney to know:

Additional Information

Have you used our law firm in the past?*

Yes
No

Would you like us to call you?*

Yes
No

Disclaimer*

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.