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2. PLEASE CONTACT THE COURT AT 979-415-2757 TO VERIFY CASE STATUS BEFORE PROCESSING YOUR REQUEST.
4. Defendant:*
5. Ticket #: *
7. I hereby enter a plea of
8. Plea*

   1. Guilty
   2. No Contest
10. I would like to request a payment agreement for the full amount of the following violations on my citation:
12. Violation:*
13. Violation:
14. Violation:
16. I agree to pay all fines and costs at the designated interval selected below, with my first payment to be made two weeks from the date this request is submitted to the court.
18. Designated Intervals*

    1. $25 every week
    2. $50 every 2 weeks
    3. $100 monthly
20. I understand an additional fee will be applied to any unpaid balance if the total amount owed is not paid on or before 30 days from the date of final judgment. I also understand that choosing this option will result in a conviction being entered and the violation(s) may be reported to the Texas Department of Public Safety, which may affect my driver license.
22. IF I FAIL TO MAKE PAYMENTS AS SCHEDULED, A WARRANT WILL BE ISSUED ON EACH OPEN CASE FOR MY ARREST FOR THE REMAINING AMOUNT OF THE FINE AND COSTS PLUS WARRANT FEES.
24. I hereby affirm that all of the above is true and correct. By entering my information below I am acknowledging that I am the person named as the defendant in this case.
26. Please forward my payment receipts to the following address and I understand I am required to notify the Court of any change of address,
28. Defendant:*
30. Address1*
31. Address2
33. City*
34. State*
35. Zip*
37. Phone Number:*
38. Email*
40. Today's Date:*
    Today's Date:
42. *WARNING: Making a false entry on this form is a jailable offense and will invalidate your plea.
Leave This Blank:


44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit Submit and Print

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