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Basic Contact Info
First Name *
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Last Name *
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Birthday *
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Us Citizen *
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Occupation *
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Incident Information
Date Of Incident *
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Arrest Location *
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Reason For Police Contact *
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Charges *
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If DUI - How much alcohol (or other intoxicating substance) was consumed and when?
If DUI - Breath or Blood?
If DUI - Breath Test - what was Breathalyzer Result?
If DUI with Blood Draw - any extra comments or photos to share relative to the puncture site? Did it hurt more than other blood draws, etc.?
If DUI - anyone else in the car / involved in accident etc.?
If DUI - Height?
If DUI - Weight?
Posted Bail or Released? *
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Which Bail Company was used? Amount paid? *
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When is your First / Next Court Date? *
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If Driver's License was taken, did you receive a pink temporary license? *
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Driver's License # (if confiscated it's located on pink temporary license) *
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Driver License State *
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Driver's License Class (Regular / most drivers have Class C) *
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Any priors in CA within the past 10 years? *
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Veteran *
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Anything more that you feel we should know?

Basic Contact Info

Incident Information