Address:
39275 Mission Blvd, Suite 101, Fremont, CA 94539
Make a call:
+1 (800) 379-9330
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If you are interested in working with us then please drop us a line, we would love to hear from you.
First Name
Last Name
Occupation
Email Address
Phone Number
Best Time to Call
Anytime
Morning 8:00 AM to 12:00 Noon
Afternoon 12:00 Noon to 5:00 PM
Evening 5:00 PM to 8:00 PM
Business Hours 8:00 AM to 5:00 PM
What is your legal status in United States?
US Citizen
Permanent Resident (Green card Holder)
Employment Visa
Visitor Visa
Other
Please select legal status.
Have your ever been convicted of a DUI or entered diversion program as a result of DUI arrest?
No
Yes - Once in last 10 years
Yes - Twice in last 10 years
Yes - Once more than 10 years ago
Yes - Twice more than 10 years ago
Please select previous DUI status
Have your ever been convicted of a crime?
No
Yes - One Misdemeanor
Yes - Two or more Misdemeanor
Yes - One or more Felonies
Please select past conviction status
City where arrested?
Date of arrest?
Why were you stopped by law enforcement?
Traffic Stop
DUI Checkpoint
Accident
Other
Please select the reason you were stopped by law enforcement.
If accident, was anybody hurt?
No Accident
No Injuries
Yes (Minor Injuries)
Yes (Major Injuries)
Please select if it was accident and someone got hurt.
What was the status of your driver's license at the time of incident?
Valid California license
Valid out of state license
No license
International license
Suspended license
Other
Please select the driving license status at time of DUI.
What was the status of your vehicle insurance at the time of incident?
Valid insurance
Uninsured
Insurance expired
Please select the vehicle insurance status at time of DUI.
Did you have any passengers in your vehicle?
Yes
No
Please select if there were passengers in vehicle.
Was there minor (under age 14) in the vehicle at the time?
Yes
No
Please select if there were minor in vehicle.
What were you drinking on day of incident?
Number of drinks
1-2
3-4
5-6
7-8
9-10
11 or more
Please select number of drinks you had.
What type of test was taken?
Blood
Breath
Please select type of DUI test.
What was your blood/breath result?
Don't know
Refused
Below .08%
.08 - .099
.100 - .109
.110 - .119
.120 - .129
.130 - .139
.140 - .149
.150 - .159
.160 - .169
.170 - .179
.180 - .189
.190 - .199
.200 - .209
.210 - .219
.220 - .229
.230 - .239
.240 - .249
.250 - .259
.260 - .299
.30 or above
Please select number of drinks you had.
Did you admit to drinking/use of drugs?
No
Yes (Drinks)
Yes (Drugs)
Yes (Prescription Drugs)
Please select if you admit to drink/drug usage.
Explain what happened
SUBMIT