Hire Us Now | The Ticket Clinic

Please fill out this form below. Please note, until you receive confirmation from our office you have not retained and attorney for your case.

Hire Us Now Form

First Name*:
Last Name*:
Street Address*:
City*:
State*:
Zip Code*:
Home phone number*:
Phone at Place of Employment:
Place of Employment:
E-mail*:
Drivers License Number*:
Your Social Security Number:
Date of Birth (MM/DD/YYYY):
Referred By:
County you received Citation(s)*:
Legal Problem: Please state kind of ticket you received*:
Enter your citation number(s) & the date of the citation(s)
Citation Number*:
Date of issue(MM/DD/YYYY)*:
State*:
County*:
Citation Number:
Date of issue(MM/DD/YYYY):
State:
County:
Citation Number:
Date of issue(MM/DD/YYYY):
State:
County:
Citation Number:
Date of issue(MM/DD/YYYY):
State:
County:
Payment Information
Choice of Credit Card*:
Credit Card Number*:
Credit Card CVS Code*:
The Card Identification Number (Card ID) is required for AMEX, Visa and Mastercard*:
Expiration Date(Month/Year)*:
Name on the Credit Card*:

TERMS AND CONDITIONS

Prospective Client understands that he/she has not retained The Ticket Clinic until payment has been received and Client has received written confirmation from The Ticket Clinic, that The Ticket Clinic has been retained.  Automatic confirmation of receipt of your e mail to us IS NOT confirmation that The Ticket Clinic has been retained, only that we have received your information. Until you hear from us, we do not represent you.

Attorneys fees are not based upon an hourly rate and, to the extent permitted under Florida legal ethics rules, are non refundable; and are earned immediately. The fee is exclusive of appeals, fines or court costs.  If court costs, fines, or traffic school is imposed the Prospective Client shall remain solely responsible for payment of same. the Ticket Clinic does not offer a money back guarantee, except where otherwise specifically set forth in writing.

No representations have been made to the Prospective Client concerning the probability of success in his/her case, and no representations have been made as to which attorney will represent him/her, and an attorney employed by the firm may be substituted to represent the Prospective Client. The Ticket Clinic may arrange for local counsel to represent the Prospective Client, at no additional cost to the Prospective Client for their participation in the case.

Prospective Client authorizes the Ticket Clinic or any attorney employed or rassociated by said firm to represent Prospective Client, to maintain Prospective Clients not guilty plea, and defend the case at trial in Prospective Client's absence. No promises or representations not set forth herein have been made to Prospective Client.

You must agree to our terms and conditions before submission:

I AGREE