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Future Forensics™ Fax assignment worksheet
date faxed_______________ who is paying
attorney _________________ office___ client___
law firm_________________ prepay Y N
address__________________ retainer Y N
________________________ vehicle repaired
________________________
Y N
phone___________________ repair shop_______
phone___________
date of loss _______
client____________________ vehicle __________
address__________________ insurance est Y N
_________________________ ins. co. __________
_________________________ ins. est $__________
_________________________ body shop Y N
phone____________________ est. amount _______
other ____________________ referred by________
service requested___________
do you need a price list? - fax number ___________
notes or special instructions:
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Future Forensics™ (206) 362-2835 (888) 362-2511
Fax this form to 206-367-4318 (it will be
dispatched to the proper office in the proper city) |