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STEP 1: Client Information This person will be our primary point of contact and is financially responsible for the project.   * Name: * Company: * Mailing Address: * City, State Zip: * Email: * Business: () - x Cell: () - Fax: () -

STEP 2: Project Information Use the description box to provide us with any information we will need to know prior to assessing the structure and choose the deliverables you wish to receive.   Project Description: Reference/Claim Number: Deliverables: Condition Assessment [Bound Report w/ Photos] The scope of this assessment is to collect information on the subject structure in an attempt to determine the type and extent of damage to the structure's components and/or systems. This assessment will include a visual non-destructive evaluation and will discuss or outline additional investigations/testing if deemed to be required. Restoration Plans & Details [Drawings] The scope of these drawings is to supplement, support, illustrate and provide permit ready drawings to advance restoration and/or repairs. These plans are prepared based on the information collected during our site visit and/or subsequent investigations. Other: [Please specify, 1 item per line] Note: Requests for non-standard deliverables will be handled on a case-by-case basis.

STEP 3: Subject Structure & Owner Information This is the structure that you would like us to assess. Please fill in all required fields.   * Owner Name: * Address: * City, State Zip: Home: ()- Cell: ()- Work: ()- x Email:

STEP 4: Third Party Contact Information Check the box below if you would like us to contact a someone other than the property owner to schedule any visits to the subject structure. Please provide as much information as possible to avoid delays. Please contact a third party to schedule visits to the structure You must check the box to enable the fields below. Contact Name: Address: City, State Zip: Home: ()- Cell: ()- Work: ()- x Email:

STEP 5: Verify your submission and submit This increases security and helps us prevent abuse by spammers.       I can't read this code * Enter the code:  (Codes are Case-Sensitive) CODES WILL ONLY CONTAIN LETTERS A-F AND NUMBERS 1-6