Speed-Right Information Form
To schedule your speedometer calibration, please complete all fields below and upload the required documents. A member of our team will contact you to confirm your appointment time and location.
Client Information
Client Full Legal Name
*
First Name
Middle Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Are you using an attorney?
*
Yes
No
Attorney Name
First Name
Last Name
Attorney Email Adress
Vehicle Information
Vehicle Year
*
Vehicle Make
*
Vehicle Model
*
Registered Owner(s)
Please type this information exactly as it is written on your registration.
License Plate Number
*
Current Odometer Reading
*
Document Uploads
Photo of Driver’s License
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Photo of Vehicle Registration
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Photo of License Plate
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Photo of Odometer Reading
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Copy of Speeding Ticket
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Attorney Contact Information (if represented)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Scheduling
Preferred Time of Day
*
Please Select
Morning
Afternoon
Evening
Please note — suggested times are not confirmed appointments. We'll review your preferences and coordinate with our technicians to find the most efficient schedule for both parties. A team member will reach out to confirm your final appointment details.
Preferred Day of The Week
Please Select
Monday
Tuesday
Wednesday
Thursday
Friday Saturday
Preferred Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Please note — suggested dates are not confirmed appointments. We'll review your preferences and coordinate with our technicians to find the most efficient schedule for both parties. A team member will reach out to confirm your final appointment details.
Preferred Meeting Location
*
Please Select
Lynchburg, VA
Roanoke, VA
Richmond, VA
Gretna, VA
Madison Heights, VA
Danville, VA
Farmville, VA
Staunton, VA
Other
We'll get as close to you as possible. Location suggestions help us plan but are not guaranteed.
Court Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Notes / Special Requests
If your court date is within 10 days, please note it below so we can prioritize your appointment.
Payment Acknowledgment
Service Fee Acknowledgment
*
Standard Service Fee ($175)
Preferred Payment Method
*
Cash
Venmo
Cash App
Submit
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