Request for Quote - Tickets/Class C Offenses

Traffic Ticket Quote Request and Intake Form

Thank you for scheduling with BLWLEGAL GROUP. Please complete this form to the best of your ability. This will allow the legal representative to best assist you on your call back or email.
UPLOAD Drivers License or TX ID if you have it.

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Your Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Your E-mail Address *
Best Phone Number *

Area Code Phone Number
Sex *

Male Female
Date of Birth *

Month Day Year
Driver's License Number
State Where Driver's License Was Issued
Type of License *

Regular Driver's License Commercial Driver's License Identification Card
Is your Driver's License or Identification Card in good standing?

Yes No
Citizenship

United States Citizen Non- US Citizen
Employer
Have you taken the Driver's Education Course in the pass 12 months? *

Yes No
Your Ticket Information
What city or county are your ticket(s) with?
Date(s) Ticket was received.
Offense of Ticket?
Did you previously have an attorney on either ticket? If, so who was the attorney?
Citation Numbers
Have you agreed to a payment plan or plead guilty/no contest on the ticket(s)? *
How did you hear about BLWLEGAL GROUP? *
Any Additional Information We Need to Know.
Do you need you legal help with any other area of law? *

Criminal Defense Personal Injury Family Law I do not need help with any other area of law.
Legal - Attorney/Client Agreement

The agreement to represent potential client is not bounding until attorney's office receives payment. Client understands this agreement bounds them to pay full attorney's fees either in one payment or in a payment plan as agreed to in writing by Attorney. Client understands warrant generally will take up to 1 week for warrant to be removed. Case will be sent for a court date. Attorney will inform Client if she/he needs to be present for court. At court, the Attorney reviews discovery to work towards a dismissal. However, if a dismissal is not possible, Attorney works out the best possible plea agreement to reduce the fine and make sure ticket does not go on client's record.
Accept Terms

I have read the terms of service above. I understand and agree to the terms of service.
Signature
Today's Date

Month Day Year
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Traffic Ticket Quote Request and Intake Form

Your Ticket Information

Legal - Attorney/Client Agreement