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South Carolina Traffic Ticket Intake & Agreement Form
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Indicates required field
Name
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First
Last
Address
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City
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State
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Zip Code
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Date of Birth
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Phone Number
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Email
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TICKET INFORMATION:
County where ticket was received
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Court Date
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Charges: (Please list the exact speed and speed limit and any additional charges on the ticket.)
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DRIVING HISTORY:
Other than this ticket, have you received any other tickets in the last three years? If yes, please state what it was and what happend with it.
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Has anyone on your insurance policy used a prayer for judgment continued in the last three years?
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Do you have a commerical drivers license?
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Has anyone on your insurance policy been had an at-fault accident of $1800 or less in the last three years?
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PAYMENT INFORMATION
Payment will be made through:
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This form
Over the phone
Already paid
Mailing in payment
In person
Card Type
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Visa
Mastercard
Discover
American Express
Card Number & Expiration Date
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LEGAL SERVICE AGREEMENT
The Contract for Legal Services, (Agreement) entered into by and between Lee and Lee Law Firm (Law Firm) and the Defendant named below.
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The Defendant agrees to pay the Law Firm the following amount.
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Please Check
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The Law Firm shall represent the Defendant soley in the traffic matter indicated in the intake form.
Please Check
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I agree that the Agreement applies only to the plea of the case and does not apply to the filing of any motions, trial or appeal of the case.
Please Check
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The Defendant agrees that this is a fee for legal servcies, and does not include any court costs, and no portion of the fee will be returned to the client, regardless of the outcome of the case. This fee is treated as a fee for legal services and it will be considered earned upon receipt. No portion of the fee will be returned or refunded.
Please Check
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The Defendant agrees that he is at all times responsible for all documents need for his defense. Defendant is responsible for all court costs, fines that may be imposed by the court or the DMV. Failure to pay these fines on time, may result in late fees or license suspension or a warrant being issued for your arrest.
Please Check
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The Defendant agrees to accept all communications via electronic mail (email) at the email address provided in the Client Information section of this form and that I am solely responsible for contacting the Law Firm, in writing, and updating any changes in any such Client Information.
Please Check
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The Defendant acknowledges that the Law Firm gauges the potential outcomes of a case based on the information given on the Traffic Intake Form and that any errors in this form may cause the legal opinions of the Law Firm to not apply to the actual and correct information pertaining to the case.
Please Check
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The Defendant agrees that he has not been made any promises as regards to the outcome of the case and that he may not demand any specific reduction.
Please Check
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The Defendant agrees that he has read and understood the terms of the Agreement and that by checking the box, he is binding himself to the terms of this Agreement.
Date
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WAIVER OF PERSONAL APPEARANCE
Choose Any
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Pursuant to NCGS 15A-101(a)(3), I waive my constitutional right to appear for tiral and authorize Aaron R. Lee, Kelsey L. Lee or, Of Counsel, to enter a plea on my behalf. I agree to be bound by the Judgment of the court and to be solely responsible for payment of any court costs or fines as determined by the court.
Date
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Submit
