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3D Scanning Assignment
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Requestor's Name
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First
Last
Requestor's Email
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Requestor's Phone #
*
Requestor's Company Name
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Date of Loss
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Loss Location
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Type of Loss
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Fire
Water
Other (explain below)
Requested Services
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3D Scan of Loss Site: pre-mitigation
3D Scan of Loss Site: post-mitigation
3D Scan of Loss Site: repairs completed
Digital Photographs
Physical Measurements
Other (explain below)
Loss Site Contact Person
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Loss Site Contact Person Phone #
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Assignment Information
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I agree to receiving marketing and promotional materials
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