FREE CONSULTATION FORM

 
  Enter as much information as possible. Fields with (*) are required.
If you prefer to speak with an agent directly, please CALL Toll Free 1-888-666-COPS(2677)
You may also print this form and fax it in. Fax Toll Free: 1-800-463-7700.
We have court agent representatives throughout Ontario.
*Title:
 *Full Name:
Address:
Apt/Unit/POBox:
*City/Province:
Postal Code/Zip:
*Home Ph.:
 ( ) *Bus. : ( ) Ext.
*Other (cell,pager):
 ( ) *E-mail:
-----------------------------------OFFENCE INFORMATION (CHARGE & TICKET NUMBER)---------------------------------
Ticket 1.)
Ticket 2.)
Ticket 3.)
Ticket 4.)
Ticket 5.)
Accident Involved?
Officer Name & Number
* Court Location:
 *Court Date(If Any):
Licence Class:
Current Demerit Pts.:
*Convictions in last 5 years?
Synopsis of Incident/
Comments/Questions
If you would like C.O.P.S. to manage the entire ticket process please type "YES" in the box:


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