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Client Intake Form
Client Intake Form
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Client Intake Form
Client Intake Form
CONTACT INFORMATION
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LICENSE INFORMATION
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Your Information
What is your occupation/job title?
Referrals
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TICKET INFORMATION
Ticket Number
Violation Date
Violation
ADULT SEAT BELT
BACKING UNSAFELY
CELLPHONE
CHILD SEAT BELT
DANGEROUS DRIVER
DISOBEY GREEN ARROW
DISOBEY STEADY RED
DISOBEY TRAFFIC DEVICE
DRIVER NO SEAT BELT
DROVE WRONG WAY
DUI
DWI
EXCESS WGHT LT 18000
EZ PASS
FLD TO COMPLY WITH ORD
FAIL TO STOP SCHOOL BUS
FAIL TO TURN AS REQ.
FLD PRESENT DOC -NYC
FLD TO SIGNAL LANE CHANGE
FLD TO STOP AT SIGN
FLD TO YLD PED CROSSWALK
FLD TO YLD TO EM.VH
FLD TO YLD TO PED
FOLLOW TOO CLOSELY
GREEN ARROW
IMP LEFT TURN-2WAY
IMPROPER CELLPHONE USE
IMPROPER RIGHT TURN
IMPROPER RT TURN INTER
IMPROPER SIGNAL
IMPROPER TAXI P/U
IMPROPER TURN
IMPROPER USE BUS LANE
IMPROPER UTURN
INSUFFICENT TURN SIGNAL
MOVED FROM LANE UNSAFE
NO SEAT BELT
NO UTURN
NYC REDLIGHT
OBSTRUCT CROSSWALK
OBSTRUCT INTERSECTION
OBSTRUCT TRAFFIC LANE NYC
OFF TRUCK ROUTE
OPEN CONTAINER
OP MV PORT ELEC DEV
OVRLOAD SING AXL NYC
RECKLESS DRIVING
RED ARROW
REDLIGHT
SCHOOL BUS
SPEED IN ZONE 1-10
SPEED IN ZONE 11-20
SPEED IN ZONE 11-30
SPEED IN ZONE 21-30
SPEED IN ZONE 31+
SPEED IN ZONE 31-40
SPEED UNPOSTED 11-30 NYC
SPILL BACK
SP-N/REA-PRUD
STOP SIGN
TRUCK RTE VIOLS NYC
UNLICENSED OPERATOR
UNPOSTED SPEED
UNREGISTERED VEHICLE
UTURN BUSIN DIST NYC
VEHICLE EQUIP VIOLATION
Other
County Where Ticket Was Written
Albany County
Allegany County
Bronx County
Broome County
Cattaraugus County
Cayuga County
Chautauqua County
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Chenango County
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