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2. Juror Summons Information
   If you have received a juror summons, please enter the following information required by the Code of Virginia § 8.01-353. If you submit your information online you do not need to call and leave your information on the jury line. If you would like a confirmation email, please enter your email below.
4. First Name of Juror*
5. Last Name of Juror*
7. Is my address different than the summons?*

   1. Yes
   2. No
8. Street Address of Juror*
10. City of Juror*
11. State of Juror*
12. Zip of Juror*
14. Age of Juror*
15. Phone Number 1 of Juror*
    Phone number that is easiest to reach you (cell or home).
16. Phone Number 2 of Juror
    Enter a second number if you have one.
18. Occupation of Juror*
19. Employer of Juror*
20. What is your first day of court?
    What is your first day of court?
    Enter the day of the first jury you have been summonsed.
22. Email Address*
24. Additional Comments
    Please let the court know if you have received this summons in error or if you have any additional comments.
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