Traffic Ticket Intake Form

• PERSONAL INFORMATION

• First Name * :

• Last Name * :

• Middle Name :

• Date of Birth :JanFebMarAprMayJuneJulyAugSepOctNovDec1234567891011121314151617181920212223242526272829303119401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010

• Address * :

•  Please Note The Address You Provide Will Be Our Primary Means Of Communication With You

• Apartment Number :

• City * :

• State * :

• Zip Code * :

• Cell Phone Number * :

• Home Phone * :

• Emergency Contact Phone Number * :

• Your Email * :

• Do you have a valid driver's license? :YesNo

• Driver's License Number :

• Do you have a commercial driver's license? :YesNo

• TICKET INFORMATION

• Ticket or Citation Number :

• What Court is Your Ticket In? :

• What were you given the ticket for? :

• Is your ticket past due or in warrant status? :YesNo

• Have you taken Defensive Driving in the past twelve (12) months? :YesNo

• Do you have a court date scheduled? If so, on what date and time? :

• Do you have insurance coverage? :YesNo

• Additional comments or questions :

• Additional Forms :

• Agree to Terms and Conditions

• 1. I, hereinafter known as CLIENT, do hereby employ, LONDON & LONDON, hereinafter known as ATTORNEY, to represent me for the Class 'C' tickets designated below. 2. In consideration of such representation, I agree to pay to my attorney a non-refundable fee as aninitial retainer fee. I understand and agree that the fee DOES NOT include a trial. 3. Client understands and agrees that no promises or guarantees have been made as to the outcome of any case(s). 4. Client understands that it can take up to seven (7) business days for a warrant to be lifted depending on the court in which the warrant is located. In some circumstances, Client may be required to provide an original signature on the surety bond. 5. Client consents to the association of counsel. I authorize the Attorney, or Associated Counsel, to sign my name to any documents necessary in my representation. I authorize the Attorney, or Associated Counsel, to plea my case(s) if I am not present in court. 6. Client agrees to pay any fines, court costs, and expenses that may be assessed or charged in the above case(s). I understand that if any fines or court costs assessed in the above case(s) are not paid by me, a warrant will be issued for my arrest. I understand that the fee paid does not include appearance at show cause hearings. 7. Client understands that certain courts may require payment upfront, proof of current insurance, and/or proof of a valid drivers license to receive deferred adjudication. 8. Client understands that in some circumstances, Attorney may appeal the citation to the County Court if the Attorney deems it to be in the Client's best interest. 9. Client agrees to contact the Attorney immediately if contact information changes. Failure to contact the Attorney of any changes in contact information may result in warrants being issued. 10. If Client violates any of the contractual terms, or pursues unlawful activity, the Attorney may withdraw. 11. 'I hereby designate the Attorney, and Associated Counsel, listed in this contract as my true and lawful attorney, in fact as well as in law, and authorize him to sign my name to any appearance bond, or other legal document, and to acknowledge same before a Notary Public, as fully as if I signed myself. Additionally, I further authorize the attorney, or their representative, to appear in court on my behalf in the case wherein I am charged, or may be charged, as a result of my arrest, and to enter a plea of either 'guilty' or 'not guilty' on my behalf, as he may see fit; and he has express authority to bind me fully, as if I were present in court myself, and he may file any motions that he may see fit to file on my behalf. I further give him express authority to waive my appearance at any proceeding with reference to this case and to appear on my behalf. I further waive any right to a jury trial and will give the attorney express authority to enter a plea on my behalf, even if that plea negatively affects my license, liberty or pecuniary interests.' 12. Client gives attorney express authority to enter into agreements with the North Texas Toll Authority (NTTA) on my behalf. 13. I understand the following: A conviction or Deferred Disposition may have immigration consequences; A plea of 'guilty' or 'no contest' may result in deportation; Immigration Law is a specialized field of law, and thisAttorney is not an Immigration Lawyer; I should consult an Immigration Attorney if I want advice on this subject. 14. I waive my right to a trial and request my attorney to obtain the best plea bargain agreement he can obtain on my above case(s). I agree to pay the fee(s), or charge(s), assessed within the time allowed. I understand I must be present in court or risk convictions on my record. 15. I agree to deliver to my Attorney any proof (e.g., current insurance and insurance at time of offense, inspection, registration) or evidence, to aid in the management of my case, within 24 hours of submitting this contract. Failure to comply may result in a plea bargain agreement, wherein I may be found guilty or granted deferred disposition, and a fine assessed. I agree to submit any proof or evidence not submitted with this contract by FAX. Any documents must include your Full Name, Date of Birth, Drivers' License Number and Account Number. 16. I understand that in rare circumstances if I fail to appear in court and the attorney believes a plea is not in my best interest, the Attorney may chose not to enter a plea in order to give you another opportunity to appear in court which may result in Client posting a cash bond. 17. I agree to be notified by EMAIL, FAX, TELEPHONE, or MAIL for all court settings and court results given to the Attorney, but the primary means of notification will be MAIL. 18. I have never entered a guilty or no contest plea or have made any other arrangements with the court for any of the citations listed above that I have employed London & London to handle. 19. I agree to pay any deferred fees, court costs, and other fines including taking defensive driving if ordered by the court. If defensive driving is required, I am responsible to schedule classes and follow up with the order of the court. 20. I AGREE IN THE EVENT MY TICKETS ARE IN CAPIAS WARRANT STATUS , LONDON & LONDON SHALL RETAIN $50 PER CITATION AS AN INVESTIGATION FEE, AND NOTIFY ME OF THE AMOUNTS DUE. 21. IF SOMEONE HAS SUBMITTED THIS CONTRACT FOR YOU, YOU HAVE THIRTY (30) DAYS TO NOTIFY THE ATTORNEY IF YOU OBJECT TO ANY PORTION OF THIS CONTRACT.

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• By Submitting Intake Form, you agree to Terms of Service

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