Free Case Evaluation

Full Legal Name:

Name You Go By:

Birth Date:

Home Telephone:

Business Telephone:

Cell Number:

E-mail Address:

Place of Employment:

Job Title:

The Charge You Were Arrested For:

Have you ever been charged with, or convicted of, a crime in the past? ?

If so, please state when, where and the nature of the charge:

Name, Address and Phone Number of Alternate Contact:

How Did You Hear About Us:


Date of Arrest:
Drivers License Number:

Did you submit a breath test?

If yes, what were the results of the breath test?

Have you ever been charged with, diverted on, or convicted of a DUI before?

Finally, please give us a summary of the reason you were stopped. Be sure to include any facts unique to your case or things you think we should know:

Reload Image

Before you send this form, here are a few things to keep in mind:

If you contact our law firm over the internet via email or form submission, no confidential information should be transmitted as it may not be considered privileged or confidential. The receipt of an e-mail from our law firm, even in response to a specific question, does not create an attorney-client relationship. No attorney client relationship is created absent an express agreement between the firm and the viewer.

All fields are required!
Please make sure that you have completed all of the fields in this form.

Not doing so can slow down the process of case analysis.