Consultation Request Form 2017-11-05T19:00:21+00:00

Consultation Request Form

We seek to understand your position and the specifics of your case in our initial consultation. By filling out as much of the form below as you can, you will help us get a head start on your case.

Your Name (required)

Your Street Address

Your Email (required)

How Did You Hear About Our Firm?

Employment

Phone Number - Primary

Phone Number - Secondary

Date of Birth

Your Age

SSN#

Driver's License Number

Please List The Current Charges Against You

Please List The Ticket Numbers (If Applicable)

Date Of The Incident

City/County Where The Incident Took Place

Do You Have Any Known Warrants?

Please list Any Past Tickets / Charges (Include County)

Have you had previous DWUI/DUI offenses? (DWI/DUI Clients Only)

Did you take a breathalyzer test or did you refuse? (DWI/DUI Clients Only)

Contact Us

We seek to understand your position and the specifics of your case in our initial consultation.

2974 East Battlefield Springfield, MO 65804

Phone:(417) 882-9300
Fax: (417) 882-9310

Dee Wampler | dee@deewampler.com
Joe Passanise | joe@entrapped.com
Scott Pierson | scott@deewampler.com
Shawna Kipp | shawna@deewampler.com
Rachel Veatch | rachel@deewampler.com
Sarah Greer | sarah@deewampler.com
Sandy Ellis | sandy@deewampler.com

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1800DUILAWS