White Collar Crime Contact Form

*First Name

*Last Name

*Email Address

*Phone Number

*Zip

Street Address

Apt/Ste

Incident Street Address

Incident Apt/Ste

*Incident Zip

Business Phone

Cellular or Pager

Does this matter involve your employer
Yes  No 

If yes, please provide the following:

Employer

Address

City

State

Zip

Webpage

Main Phone

Job title and description (including areas of responsibility)

Were you arrested
Yes  No 

If yes, please provide the following information:

Booking #

Court Date

Time

Court Name

Division/Room

Arresting Officer's Name and Badge

City of Arrest

What were you arrested for (include Code section if known)

Have you been convicted of a similar crime before
Yes  No 

If yes, when

Have you been convicted of other offenses
Yes  No 

If yes, what and when

Are you on probation or parole
Yes  No 

For what

Do you have any other cases pending

Was anyone else arrested
Yes  No 

If so, name all persons arrested

What statements do you remember making to the police about the alleged crime

Describe the order of events leading up to the arrest or your need for advice

Have you discussed the alleged crime with anybody else
Yes  No 

If so, who did you discuss it with and what did you tell them?

Were there any witnesses to the alleged crime
Yes  No 

If yes, provide names and contact information if known

Were there any other individuals involved in the alleged crime
Yes  No 

If yes, provide names and contact information if known

What is the amount of the bond you posted

Are there any special bond conditions
Yes  No 

Were you referred by somebody else
Yes  No 

Who

Special concerns

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