The My Tikkit Law Firm
Traffic Law Specialists
Intake Form
Kindly complete this form. Please enter all the information as accurate as possible. Thank you!
Client Name
*
First Name
Last Name
Date of Birth
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Month
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Day
Year
Date
Driver License No.
*
A123456789
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Phone Number
*
Please enter a valid phone number.
Secondary Phone Number
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How did you hear of us?
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Please explain, in as much detail as possible, the events surrounding your traffic offense?
*
Date of Offense/Date Ticket was Issued
*
-
Month
-
Day
Year
Date
Upload File
Are you a Michigan resident?
*
Yes
No
If you are not a Michigan resident, please indicate what City and State you reside in?
Are you completing this form for yourself?
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If you are completing this form on behalf of someone else, please state your relationship to that person.
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If you answered “Other” above, please provide details.
Please feel free to share with us any other details you would like us to know so that we can best serve your needs.
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Tikkit Legal Services
Legal representation for your traffic matter
$
200.00
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