Drunk Driving/DUI Contact Form

Name

Email Address

Phone Number

Business Phone

Cellular or Pager

Address

City

State

Zip

Booking #

Driver's License #

Court Date

Time

Court Name

Division/Room

Arresting Officer's Name and Badge

City of Arrest

Blood-alcohol level at time of arrest

Type of test used to determine BAC

Were field sobriety tests given?
Yes  No 

If so, describe tests and results

What specific drunk driving offense were you arrested for (include Code section)?

Have you been convicted of drunk driving before?
Yes  No 

If yes, when?

Have you been convicted of other offenses?
Yes  No 

If yes, what and when?

Are you on probation or parole?
Yes  No 

For what?

Do you have any other cases pending?

Was anyone else arrested?
Yes  No 

If so, name(s) of all persons arrested

What statements do you remember making to the police about the alleged drunk driving?

Describe the order of events leading up to the arrest

Have you discussed the alleged drunk driving with anybody else?
Yes  No 

If so, who did you discuss it with and what did you tell them?

Were there any witnesses to the alleged drunk driving?
Yes  No 

If yes, provide names and contact information if known

What is the amount of the bond you posted?

Are there any special bond conditions?

Were you referred by somebody else?
Yes  No 

Who?

Special concerns