First Name *

Last Name *

E-mail *

Phone *

Location

West Palm Beach
3167 Forest Hill Blvd
West Palm Beach, FL 33406

Please select a date and time that works for you *

Date of Birth

Driver's License Number

County ticket issued

Citation #, Ticket #, Case #

Course Reason Please Select One Election Court Ordered TCAC BDI Red Light Running BDI Reckless Driving BDI Racing BDI Racing Spectator BDI Passing School Bus BDI Out Of State

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