Client Intake Form

Complete this form before your consultation. Do not pay the ticket — paying online is an admission of guilt and waives your right to contest the charge.

Secure & Confidential — Attorney-Client Privilege Applies

Contact Information

Full Legal Name*

Phone Number*

Email Address*

Street Address

City

State

Zip Code

Date of Birth

Driver's License Information

Driver's License Number

License State

License Status

Do you hold a CDL (Commercial Driver\'s License)?

Citation Details

Information from the ticket itself

Citation / Ticket Number

Date of Citation

County Where Issued

Court Name

Charge(s) listed on the ticket

Your Speed (if speeding)

Posted Speed Limit

Was this in a school zone?

Was this in a construction / work zone?

Court Date

If a court date is listed on the ticket or you have received a notice

Court Date

Court Time

Court Location / Address

Driving History & Insurance

Do you have prior traffic violations in the last 3 years?

Insurance Status at Time of Citation

Insurance Carrier (if insured)

Goals & Additional Information

Have you already paid the ticket online or by mail?

What outcome are you hoping for?

Additional notes or questions

How did you hear about us?

Upload Documents

Optional — attach a photo of the ticket, court notice, or your license

Click to upload or drag and drop

PDF, Word, JPG, PNG — up to 20 MB each, max 10 files

Helpful documents: photo of the citation, any court notices you have received, copy of your driver's license.

Ready to Submit?

Your information will be sent securely to Shaffer Law Office. We will follow up within one business day.