Completing this form alone does not create an attorney/client relationship – You must take other steps outlined in the email and fee agreement you received from our office. Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.1. What is your name? *FirstLast2. What is the best phone number for us to reach you?3. What is your mailing address?Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip Code4. Do you have a commercial driver license?YesNoI don't know5. What state issued your current driver license?6. How long have you had your current driver license?Less than 4 yearsMore than 4 years6.A. In what state(s) have you held licenses in the previous 4 years?7. Have you taken Defensive Driving School (the 4-hour class) for a traffic violation you received in the last 12 months?YesNoI don't know8. Please upload copies of any driver license you have had in the previous 4 years. Click or drag a file to this area to upload. Ideally your license copy will be in a .pdf format.9. Please upload a copy of your traffic ticket(s) if you have not already provided a copy to us. Click or drag a file to this area to upload. Ideally your ticket(s) will be in a .pdf format.10. Please upload a copy of your Driving Record Click or drag a file to this area to upload. We would like a copy of your driving history. If you have an Arizona license, you can obtain a copy of your 39 month driver license motor vehicle record at azmvdnow.gov. If your license is from a state besides Arizona, google "(your state) driving history". More often than not, there is a .gov website where you can obtain your driving record online. If you run into problems, give us a call.11. If the court finds you responsible for your ticket(s) and imposes a fine, would you prefer to pay the fine:In full on the date you are found responsibleOver time through a payment plan (the court will charge an additional $20-$30 fee for time payment)12. What is your goal in this case? Submit