Defensive Driving Request Form

Defensive Driving Request Form

If you hold a Commercial Driver's License (CDL), were charged with speeding 95 mph or more, or were speeding more than 25 mph over the posted limit, you are not eligible to request a defensive driving course.
Cause Number (Citation Number) blank*
GuiltyNo Contest
I waive my right to a trial by jury and request the court defer proceedings in this case for a period of 90 days to allow me to complete a Driving Safety Course that is approved under the Texas Driver and Traffic Safety Education Act. I have not completed a Driving Safety Course in the past 12 months and am not in the process of taking a Driving Safety Course for a moving traffic violation.

I understand that this judgment will be removed upon submitting a course completion certificate, a copy of my driving record (request here) and payment. I FURTHER UNDERSTAND THAT FAILURE TO COMPLY WILL RESULT IN THE REMAINING FINE AND COSTS PAYABLE IN FULL IMMEDIATELY.

I have uploaded a copy of my driver’s license, proof of insurance in my name and submitted payment of $144. 00.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Best Contact Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email (optional but preferred)
example@example.com
Upload copy of DL & Proof of Insurance

Cancelof
I certify that the above information is true and accurate and I acknowledge that I have not requested any additional documents, items or information related to this case.
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