HTA - Violation Appeal (Certification of Non-Liability)

GENERAL APPEAL

IF YOU HAVE RECEIVED A SECOND NOTICE YOU MAY NOT APPEAL ONLINE - PLEASE CALL OUR CUSTOMER SERVICE DEPARTMENT.

This form is to be used only if you do not have a valid E-ZPass, I-Pass or AutoExpreso account and wish to dispute the violation.

Instructions for Written Appeal

Please use the form below to detail reasons you believe this violation to be issued in error, or wish to dispute this violation for any reason.
If you do not state a reason for your General Appeal, we will not be able to provide you with a response.

Please provide as much of the following information as possible in order to process your request.

PERSONAL DETAILS
Name:		Phone:
Email:
Retype Email:

RENTAL AGENCY DETAILS
Rental Car Agency:
Rental Agreement Number:

VIOLATION DETAILS
Date of Violation Notice :
Violation Number(s) :	# 1:
	# 2:
	# 3:
	# 4:
	# 5:

Dispute Deadline Date :

I hereby appeal this violation for the following reason: