Name:
Mr.
Miss
Mrs.
Ms.
Dr.
(required)
Address:
(required)
City:
(required)
Postal Code:
(required)
E-mail address:
(required)
Phone Number:
(
)
(required)
Fax Number:
(
)
Offence:
Speeding
Seatbelt
Stop Sign
Red Light
Disobey Sign
Fail to Yield
Pass off Roadway
Drive under Suspension
No Insurance
Impaired
Refuse to provide sample
Over 80 mg's
Other
(required)
Traffic Court Location:
(as stated in the 3rd option on the back of the ticket)
(required)
Incident details:
(required)
Current Number of Demerit Points:
Have you been convicted of any traffic ticket or criminal charge in the last 5 years?
Yes
No
If you prefer to speak with an agent directly, please call:
Tel: (416) 366-8729
Or fax your ticket(s) with your name and phone number to:
Fax: (416) 614-8436
Please call for an appointment. We are located at:
111 Yore Road
Toronto, Ontario, M6M 5L8
(N/E Corner of Keele & Eglinton)
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