Forms - Make a payment - Pre-Trial Diversion Payments - CCDA

''Use this form ONLY if you have been approved for a three month PTD contract (POM/POCS-THC)''

Contract Payments - 3 Month Pre-Trial Diversion

Email Address Used to contact you in case of problem with payment

Case Number Court assigned case number

Defendant’s First Name

Defendant’s Last Name

Defendant’s Date of Birth Ex: 01/15/1990

Defendant’s Address Line 1

Defendant’s Address Line 2

City

State

Zip

Defendant’s Phone Number

Defendant’s Email Address

Defense Attorney’s Name

Payment method

Payment Details

Payment amount

Convenience Fee (Credit Card) 5.00% (of subtotal)

Note: a minimum charge of $1.00 will be applied.

Total

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956-544-0849