Cocaine Lawyers in New Jersey™ invite you to provide information about your case. The questionnaire that follows uses industry-standard encryption to safeguard the confidentiality of your personal information. When you click on the “Submit” button, below, your completed form will be emailed to them. One of the Cocaine Lawyers in New Jersey™ will review your information. He will then call you to discuss your case. If you prefer to speak to one of the Cocaine Lawyers in New Jersey™ first, you can call 877-NJ-COKE-1 (877-652-6531) toll free. Or you can send an email to info@NJCocaine.com.

Contact Information

Your name
(first and last):
Your telephone:
Your email address:

Defendant Information

The person charged is: Me
Somebody else
Age of person charged: Under 18
18-21
22-30
Over 30
Previous drug-related charges: Yes
No
 
Status of person charged:		  
Still in jail
Released, no bail required
Released on bail

Incident Information

Date of incident:
Town of incident:
Charges:
(Check all that apply)		 Drug paraphernalia
Cocaine possession
Cocaine possession with intent to distribute
Possession with intent to distribute in a school zone
Possession with intent to distribute in public housing zone
Possession with intent to distribute in a public park zone
Possession with intent to distribute in a public building
Distributing (selling, sharing, or delivering) cocaine
Being under the influence of cocaine
Cds in a motor vehicle
Other motor vehicle charge or charges
Other non-motor vehicle charge or charges (please provide details in the Summary Box, below)
 
Number of people charged in this incident (including the defendant):
 		 1
2
3
4
More than 4
A court date has been set:
 		 Yes
No
Summary of Case:

Other Information You Think Might Be Helpful (Optional):

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