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Pre Application Form
Person charged with offense
Examples Below
Date of birth
10/17/1968
Sex
male
female
Current address
Primary phone number
555-555-5555
Secondary phone number
Date of arrest
10/17/2007
Alleged Charges
City / County arrested in
Arresting Agency
Gwinnett Police, State Patrol, City of LawrencevillePolice
Court Date if known
Is Defendant in jail
yes
no
How much is their Bond
$ 50,000
Prior criminal history ?
yes
no
Name of person filling out form
Primary contact phone number
Relationship with Defendant
spouse
sibling
friend
partner
Please provide your email address
hhhhh@yahoo.com
How did you hear about our Firm
Mail Advertisement
Refferal
Yellow Pages Ad
Walk In
**** By submitting this form you do not create an Attorney Client Privilege ****
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