T.E.P. Application

First Name: *

Last Name: *

Address: *

State: Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming *

Phone Number: * *

City: *

Zip Code: * *

Email Address: * *

Drivers License State: Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming *

DL Number *

Ticket Number(1): * *

Charge(1): *

Offense Date(1): * *

Agency: Select Agency -Other- Abbeville County Sheriff Abbeville Police Department Calhoun Falls Police Department Clinton Police Department Due West Police Department Erskine College Police Department Fountain Inn Police Department Greenwood County Sheriff Greenwood Police Department Hodges Police Department Honea Path Police Department Lander University Police Department Laurens County Sheriff Laurens Police Department Newberry County Sheriff Newberry Police Department Ninety Six Police Department Prosperity Police Department S C Highway Patrol Ware Shoals Police Department Whitmire Police Department *

Officer: *

Court: Select Court -Other- Abbeville Magistrate Court Abbeville Municipal Court Calhoun Falls Municipal Court Clinton Municipal Court Due West Municipal Court Fountain Inn Municipal Court Greenwood Magistrate Court Greenwood Municipal Court Laurens Magistrate Court Laurens Municipal Court Newberry Magistrate Court Newberry Municipal Court Ninety Six Municipal Court Prosperity Municipal Court Ware Shoals Municipal Court Whitmire Municipal Court *

Judge: Must Select Court *

City of Offense: Select City -Other- Abbeville Bradley Calhoun Falls Callison Chappells Clinton Conronaca Cross Hill Donalds Due West Gray Court Greenwood Helena Hodges Joanna Kinards Lanford Laurens Little Mountain Lowndesville Mountville Newberry Ninety Six Ora Owings Peak Pomaria Princeton Prosperty Shoals Junction Silverstreet Troy Verdery Ware Shoals Waterloo Whitmire *

County of Offense: Select County Abbeville Greenwood Laurens Newberry -Other- *

Ticket Number(2): *

Charge(2): *

Offense Date(2): * *