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2. WHO SHOULD USE THIS FORM

   You may be eligible for a payment plan for most suspension termination fees, other fees, fines, and surcharges you owe for traffic tickets if:

   * You pleaded guilty to a traffic violation or a reduced plea, or

   * You have been found guilty at Traffic Court, or

   * You have been default convicted.

   
   

   All payment plans are $25 per month. You may pay more than the monthly payment or pay in full at any time.

   Use this form only if you have received a traffic ticket in the City of Buffalo that is returnable to the Buffalo Traffic Violations Agency.

   
   

4. First Name*
5. Last Name*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Phone Number*
14. Driver's License Number*
16. Email Address*
18. Are you already enrolled in a Buffalo Traffic Violations payment plan?*

    1. Yes
    2. No
20. Ticket Information

    In order to expedite your request, please include a ticket number (view a sample ticket). Your payment plan will include any and all Buffalo Traffic Violations Agency traffic tickets you owe. Do not submit more than one application if you have multiple tickets.

22. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    False statements made herein are punishable as a Class A Misdemeanor pursuant to section 210.45 of the penal law of the state of New York.

    1. I agree.
24. Electronic Signature
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field