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2. I have been retained by the named defendant below to represent him/her with regard to a citation. I am hereby requesting a pre-trial conference during the Attorney's Docket to this matter.
4. Additional Documents

   If you have your own Letter of Representation, you may upload your document here.

8. Defendant's First Name
9. Defendant's Last Name
10. Date of Birth
    Date of Birth
12. Date of Violation
    Date of Violation
13. Citation / Cause Number(s)
17. Attorney Name
18. State Bar ID Number*
20. Attorney's Email Address
22. Address
24. City
25. State
26. Zip Code
28. Phone Number
29. Fax Number
31. E-Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) the information you supplied is true and correct, 2) your request will not be signed in the sense of a traditional paper document, 3) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 4) you may still be required to provide a traditional signature at a later date.

    1. I agree
33. Electronic Signature*
34. Date of Signing*
    Date of Signing
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field