CONFIDENTIAL DWI INQUIRY FORM  

If you or a loved one is charged with DWI or any other crime, please provide as much information as possible and submit the form below. A lawyer will review your submission and call or email to discuss your case.

Use of this form does not create an attorney-client relationship. Regardless of whether or not we accept your case, all material and information submitted is, and will be, held in the strictest confidence, and will not be shared with anyone outside the firm.

Mailing Address *
Mailing Address
Phone *
Phone
Please Provide the Best Number to Reach You
Sex
I am Inquiring For *
Please list the Vehicle and Traffic Law violations from the tickets, if known. If you do not know, please write "I don't know."
Date of Arrest
Date of Arrest
Did You Provide a Chemical Breath Test? *
Did you blow into the breathalyzer at the police station?
Was Your Blood Alcohol Content (BAC)? This information is typically found on the right-hand side of the "DWI Bill of Particulars." If you did not receive a Bill of Particulars, please write "I don't know."
Have You Been Charged with DWI in the Past? *
Please provide the city or town where you were arrested, and the court where you are supposed to appear. This information will appear on the bottom of your tickets.
If you have any specific questions or concerns, please write them here.
DISCLAIMER *
I UNDERSTAND AND AGREE THAT BY SUBMITTING THIS FORM I AM NOT HIRING AN ATTORNEY, AND THAT NO ATTORNEY-CLIENT RELATIONSHIP IS FORMED. I FURTHER UNDERSTAND AND AGREE THAT ALL INFORMATION SUBMITTED IS CONFIDENTIAL, AND WILL NOT BE PROVIDED TO ANY THIRD PARTY WITHOUT MY EXPRESS WRITTEN CONSENT. I HEREBY CONSENT TO BE CONTACTED BY AN ATTORNEY FROM THE BRESLIN LAW GROUP TO DISCUSS MY CASE.