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Amelia Virginia DUI / DWI Free Evaluation

If you believe that you or someone close to you may have a DUI / DWI matter and may require legal counsel in
Amelia County, Virginia please fill out the following questionnaire. By submitting the information below, you will enable the Attorneys to evaluate your case based on its merits. Please be as complete as possible in the information you provide.

If you have a potential case NOT related to a DUI / DWI charge, please fill out our
 Amelia County, Virginia Free Traffic Citation Questionnaire.

 * = Required Field

DUI / DWI Contact Information:
* Please let us know how you found our site.   

 

 
* First Name:    

* Last Name:  

* Address:         Address Cont.:
*  City:              *  State:        
*  Zip Code:       
 

How do you prefer for the attorney to contact you? (Check all that apply)
* E-mail:        

 

* Home Number: (xxx) xxx-xxxx    

 
  Work Number: (xxx) xxx-xxxx      

 

   Alt. Number: (Cell. etc.)             

 

Best time to contact you: (i.e. After 1pm)        

DUI / DWI Incident Information:

How would you like to plead in this incident? 
   
* What date did the incident occur?  / / At what time?    
What was the traffic flow at the time? What were the driving conditions?
* When is the court date?   / / Time of court? 
* Name of Court?   
Date of birth: (optional) / /  
Driver's License Number?: (optional)      
Issued in what state?: (optional)    
List any license restrictions?: (optional)
 
Have you ever been convicted with a DUI / DWI / OWI?  If so, list below:
List any prior DUI / DWI / OWI convictions (including in other states):
Include Date, City, State, Court Name, and Plea Result
 
Other Tickets/Charges received with this DUI / DWI / OWI? (Check all that apply):
Failure to Maintain Lane Defective Equipment
Speeding - How fast? in a  m.p.h. zone. No Proof of Insurance
Illegal U-Turn Failure to Yield
Running Red Light Other (Please specify below)

Please specify other charges not listed above:

 
Accident Information:
Was there an accident? Was anyone injured during this Incident? (Check all that apply)
No one was hurt/Not applicable Passenger(s) in another vehicle
Myself Pedestrian
Passenger(s) in my vehicle    
 
Field sobriety test (F.S.T.) Information:
Were you stopped at a roadblock?
Were you given field sobriety tests when you were stopped?  
If yes, what were the results?
Which field sobriety tests were you given? (Check all that apply):
Handheld Breath Test Follow-the-Pen-With-Eyes
Walk-and-turn 9 steps heel to toe Say the alphabet
One-Leg Stand Touch Your Nose
Other (Please specify below)    
 

Please specify other sobriety tests that you took, that are not listed above:

 
Did officer advise you that tests were 100% optional and that no penalty would result from not doing them? Yes No
Did you perform a Intoxilyzer test?
If yes, what was your blood alcohol level?
At what time of day was the Intoxilyzer test taken?
 
Did you perform a blood test?
If "yes" what were the blood test results?   Check here if blood test results are pending:
Did you get an independent blood, breath or urine test? Yes No
If "yes", what was the result?       Check here if independent test results are pending:
 
Officer / Additional Information:
What type of officer performed the arrest?  
If other type of Police official please specify.
What was the name of the arresting officer?
 
Was your car towed from the location you were arrested?
If yes, who called the tow truck?
Who posted your bond?       Amount?
Did you ever request to call an Attorney? Yes No
 

* Please briefly explain the incident:
 
 

Important Legal Disclaimers:

Yes I agree that this matter may be referred to an attorney in the Virginia area who may contact me.

Yes I agree that the information that I will receive in response to the above questionnaire is general information and I will not be charged for the response to this e-mail questionnaire.

Yes I agree that the above does not constitute a request for legal advice and that I am not forming an attorney client relationship by submitting this questionnaire I understand that I may only retain an attorney by entering into a fee agreement, and that I am not hereby entering into a fee agreement.

By Clicking the appropriate box below, I agree to:

IGotPulledOver.com assists Attorneys, Lawyers and Law Firms who help individuals arrested and charged with a traffic citation, speeding ticket, moving violation, drunk driving, driving under the influence, driving while impaired, crime or other serious traffic-related offense. DUI / DWI / OWI / OUI Attorneys, Lawyers and Law Firms help individuals who have been accused of committing DUI / DWI / OWI / OUI and traffic crimes and offenses (such as excessive speeding, speeding tickets, traffic citations, moving violations) by seeking to avoid arrest, ignition interlock, possible jail time or loss of license, by challenging the breath test (such as Breathalyzer, Breathalyser, Draeger, Datamaster II, Intoxilyzer tests), roadside tests, field sobriety tests (FST) and police radar.
Amelia Virginia DUI and Speeding Tickets handled by Experienced Lawyers. IGotPulledOver.com - DUI and Traffic Citation Attorneys in all Counties of VA - FREE Evaluation - FREE Traffic Citation Evaluation
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