Beta Coverage Form

Black-out dates/No coverages provided: 

  • Summer of 2017 JULY/AUGUST
Camino Portugues: Valenca, Portugal, 2014

Camino Portugues: Valenca, Portugal, 2014

 

If you need coverage at the Bronx TVB: 

  1. Complete form below
  2. Check Box Authorizing, Victor A. Bernace, Esq. or assigned counsel (if a bus hits me) to provide representation
  3. Check Box authorizing a charge of $75 for coverages totaling 7 points or less ($100 for 8 points or more.). 
  4. I will email you "Confirmed" usually within a couple of hours of you submitting this form so you know I'll be there.  After case is finish, I charge your credit card and email receipt. 
  5. Please make requests 2 days prior to hearing date. 
  6. After case is finished, I'll email you results usually by end of business day.

Please note: At this time, no coverages are provided for insurance, or trucking overweight/over length cases. YOUR PAYMENT IS TO PROCEED AND FINISH THE CASE, UNFORTUNATELY, I CANNOT PROVIDE PTG'ING OF CASES.

For each client, enter date/time, last name, first name, middle initial, tix #
Authorization to Proceed *
Payment Authorization *
Please call (917-405-4368) and provide me with your preferred credit card information that I will use going forward for this and future cases. I will charge the coverage fee AFTER I FINISH THE CASE, if officer is unavailable and case is REA to a future date, I won't charge you. THIS MEANS YOU NEED TO RESUBMIT THE CASE TO INSURE I COVER IT NEXT TIME. Credit Card Information is processed using Square credit card system.