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Request for Criminal Defense Representation
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Email
*
Your email
Defendant's full name
*
Your answer
Name of person filling out this form, if other than Defendant
Your answer
Which court and when is the next appearance date?
*
Your answer
Current criminal charges pending, if known
*
Your answer
Payment of attorney fee for representation:
*
I am able to retain an attorney at this time
I need time to make financial arrangements
I am indigent and need a court-appointed attorney
Phone number for phone consultation
*
Your answer
A copy of your responses will be emailed to the address you provided.
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