SUBMIT A CLAIM/ASSIGNMENT

DCA Telephone

C: 502-648-8413

O: 502-517-9311

derbycityappraisals@gmail.com

Adjuster Information

Adjuster's First Name

Adjuster's Last Name

Adjuster's Email

Adjuster's Phone Number

Company

Adjuster's Branch Address

City

State

Zip Code

Claim/Assignment Details

Claim Number

Date of Loss

Peril

Insured's First Name

Insured's Last Name

Claimant's First Name

Claimant's Last Name

Cell Phone

Address

City

State

Zip Code

Type of Assignment

Desk Review (Photos Only)

Full Inspection

Okay to Release Estimate?

Yes

Vehicle Information

VIN

Year

Make

Model

License Plate

State

Color

Deductible

Do you need a Total Loss Valuation?

Yes

Do you need Salvage Bids?

Yes

Notes/Damage Description

Attach Photos/Documents

Upload File

Upload supported file (Max 15MB)

If file is too large, please email to derbycityappraisals@gmail.com.

Assignment Received! We will open a new file and schedule an inspection as soon as possible. Thank you for choosing DCA!