File An Online Claim If you are human, leave this field blank.Repair facility detailsRepair facility name *Phone *Fax *Repair facility email *Repair Facility Address *State *Zip *Labor Time PER procedureLabor cost per hourPart PriceSales tax rateCustomer detailsContract numberCustomer first and last name *Customer phone *Email *Last 6 of VIN *Repair detailsRepair order *Current odometer reading *Loss date *Rental car issued *YesNoNumber of daysIs rental car through repair facility? *YesNoIf known, please provide rental agency detailsWas vehicle towed or driven in? *TowedDrivenIf known, please provide towing agency detailsIs this vehicle modified beyond manufacture specifications? *YesNoFor details:Is this vehicle used for business or commercial use of any sort? *YesNoFor details:Customer concernCauseMultiple concerns?YesNoCustomer concern 2Cause 2Customer concern 3Cause 3Customer concern 4Cause 4Customer concern 5Cause 5Customer concern 6Cause 6Recommended correctionsAdditional notes about repair detailsAttach repair order or estimateSubmit Get In Touch Roadside Assistance: (866) 535-2959Make A Claim: (855) 248-5700 Headquarters 167 Lamp and Lantern Village, #127Chesterfield, MO 63017855-246-6700 Email info@drcadmin.com File A Claim Roadside Assistance 866-535-2959 File A Claim Online Ask An Agent 855-248-5700 Ask A Question If you are human, leave this field blank. * *Submit
