FREE ONLINE DUI CASE EVALUATION / FREE ONLINE DUI CONSULTATION
Complete this form to receive a Comprehensive Case Evaluation from a Top-Rated Pennsylvania DUI Defense Attorney. We will provide you with: (1) A comprehensive case evaluation discussing every aspect of your case; (2) a copy of our recent case results; (3) a copy of the training manual used to train the police officer that arrested you; and (4) a free fee quote. No office visit necessary. We will send you one response by email.
The Evaluation is FREE. In addition, you will receive a $250.00 Discount if you retain our services.
What is your full name? (First & Last):
What is your COMPLETE street address including city, state & zip code?
What is your phone number including area code?
What is your email address? (Please check for accuracy.)
What is your Date of Birth?
What is the date of the incident?
In what COUNTY did the incident occur?
At the time of the incident were you licensed and insured? (Select)
How old was the youngest person in your vehicle? (Select)
Why were you stopped/detained? (Select one)
Did you admit to drinking/use of drugs?
How many drinks did you have on the date/evening of the incident?
If you are charged with DUI-Drugs please describe:
Have you EVER been convicted of a DUI or entered ARD (or similar diversionary program as a result of a DUI Arrest?
Have you ever been convicted of a crime?
Do you know your blood/breath results? (Do not include roadside breath test)
What is your docket number? Example MJ-01203-CR-1234-2016
What is the most important quality you are looking for in an attorney?
What is your goal for this case?
Is there ANYTHING else (including any medical issues that you may have) we should know about your case?
How did you learn of our firm?