a DCI Holdings Inc. company

Service of Process Form

Fields marked with "*" are required fields.

Requested By:
*First Name:
*Last Name:
Title:
*Company:
*Street Address:
*City:
*State:
*Zip:
*Phone:
Fax:
*E-mail:

Objectives:
Date Service of Process to be Completed by:
Type of Service:
Additional Information/Instructions:
Client File/Claim Number:

Customer Information:
Firm/Company Name:
Attorney/Contact Person:
Street Address:
City:
State:
Zip:
Phone:
Fax:
Firm/Company File/Claim Number:

Billing Information:
Responsible Party: Your Firm    Carrier
Carrier/Company:
Adjuster/Contact:
Street Address:
City:
State:
Zip:
Phone:
Fax:
Name of Insured:
Claim/File Number:
Date of Loss/Injury:

Case Information:
Case Name:
Case Number:
County:
Court: Superior   Municipal   WCAB   Other:
Your Firm Represents: Plantiff/Applicant   Defendant   Other:
Name:
Advance Fees: Yes     No

Document Preparation for Personal Appearance:
Deposition   WCAB   Arbitration   Civil   U.S.D.C.  
Notice to Opposing Counsel:
Firm:
Opposing Counsel's Name:
Street Address:
City:
State:
Zip:
Phone:
Fax:
List Additional Counsels:

Documents to be Served:
Documents to be Served:
Entity to be Served:

Home Address:
Name:
Street Address:
City:
State:
Zip:
Phone:
Additional Information/Instructions:

Business Address:
Business Name:
Street Address:
City:
State:
Zip:
Phone:
Additional Information/Instructions:

PLEASE BE SURE TO SEND US THE DOCUMENTS TO BE SERVED BY USING ONE OF THE FOLLOWING:   
FAX: 888-496-9423 • E-MAIL: photocopy@dci-inc.org • REGULAR MAIL

If you would like to speak to a representative, please call DCI Legal Photocopy Services at 888-457-4426.



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