Name: Document Acquisition Service
Price range: $$$

Place an Order

Submit an Order using our online interface!

Are you a current DAS client?(Required)

Current/Returning DAS Client

New Client (Have not submitted a client profile)

We would like a profile so that we can process your order most effectively, however if you would like to submit an order first, you may go ahead and check Current/Returning DAS Client. We will reach out with what we need for a client profile later.
Visit the link below to submit a client profile.

GO TO CLIENT PROFILE

Service Type(Required)

Submission Method(Required)

Request Form/Method(Required)

Order No.(Required)

Don't have order number?

Don't have order number

Client Name(Required)

Records Pertaining To(Required)

Client Info

Client/Attorney Name(Required)

Case Contact

Firm/Organization(Required)

Client Matter No

Records Pertaining To

Name(Required)

First Middle Last Suffix

Date of Birth(Required)

Date of Death

Social Security No(Required)

If you only want to enter the last 4 digits, please use 0's for the first 5 digits EX: 000-00-1234

Insurance

Claim No

Date of Loss

Insurance Company Name

Adjuster/Contact Name

Phone

Fax

Billing

Bill To(Required)

You

Direct Bill

Direct Bill the Insurance Company Info Entered Above

Direct Bill Contact

Direct Bill Contact (Required)

Name	Organization	Address	Email	Phone	Fax	Actions

There are no Direct Bill Contacts.

Case Info

Case Type(Required)

Cause No(Required)

Attorney is Representing(Required)

Represented Name(Required)

Style of Case

Left Side(Required)

§
§
§
§

Right Side(Required)

Opposing Counsel(s) of Record

Name	Organization/Firm	Bar No	Address	Email	Phone	Fax	This OC Represents	Represented Name	Actions

There are no OCs of Record.

Record Requests/Locations

Requests/Locations

Record Type(s)	Custodian Name	Other Record Type(s)	Date Range	Doctor	Email	Phone	Fax	Address	Actions

There are no Record Requests.

Upload File(s)

Upload Order Form(Required)

Drop files here or

Accepted file types: pdf, Max. file size: 128 MB.

Upload Authorization(Required)

Drop files here or

Accepted file types: pdf, Max. file size: 128 MB.

Upload Files/Attachments

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 128 MB.

Additional Information

Confirmation

Please make sure you have entered all of the information correctly then fill out your name and email address for confirmation.

Your Name(Required)

Your Email(Required)

CAPTCHA

Place an Order

Client Info

Records Pertaining To

Insurance

Billing

Case Info

Style of Case

Record Requests/Locations

Upload File(s)

Additional Information

Confirmation

Can't get something to work?

Are You Sure?

Place an Order

Client Info

Records Pertaining To

Insurance

Billing

Case Info

Style of Case

Record Requests/Locations

Upload File(s)

Additional InformationIf there is any additional information you would like to include with this order submission that you have not yet had the chance to enter, please enter it here.

Confirmation

Report Issues

Can't get something to work?

Are You Sure?

Additional Information