SUBMIT A TICKET

CUSTOMER INFORMATION
Name:
Phone Number:
Email:
Address:
City, State, Zip:
Driver's License #:
License State:
Date of Birth:

TICKET INFORMATION
Ticket #:
Court Date & Time:
City Ticket Issued In:
Offense(s):
Additional Ticket Info:
-make, model of vehicle
-license plate # and expiration
-insurance carrier
-Commercial Driver?
-issuing officer name and/or badge #
-other relevant info








Entering information into this form does not constitute the formation of an Attorney/Client relationship. This form is merely a way for you to contact our office about your violation. Remember the Law Office of Brandan Davies LLC does not represent you until a formal representation agreement has been authorized. The choice of a lawyer is an important decision and should not be based solely upon advertisements. Past results afford no guarantee of future results. Every case is different and must be judged on its own merits.