If you just received a DUI, you can't afford not to call:800-OHIODUI (800.644.6384)
The following information is subject to the attorney-client privilege. Our office will use this information to contact you to setup an appointment and schedule a free initial office consultation.
Name:
Address:
Home Phone:
Work Phone:
Email:
Best Time to Contact:
Contact Phone:
Occupation/Employment:
Date of Birth:
Social Security :
Date and Time of Arrest:
Arresting Police Agency:
Alcohol Test Result or Refused Test:
Scheduled to Appear in Which Court:
Date and Time of Court Appearance:
Comments & Questions:
Copyright © 1999 Gardner & KucharskiLast updated April 30, 1999
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