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Get BCIF 01

L: CCCValuescopeRequest@cccis.com Office ID Number Claim Number Adjr Name (First & Last) Appr Name (First & Last) Adjr Contact# Insured’s Name Owner’s Name Owner’s Phone Loss ZIP Code Loss State Loss Type Collision Theft Coverage code Collision Comprehensive Liability Other 3rd Party Claim Yes No Leased Vehicle Yes No Date of Loss Exch#Policy # Adjuster ID# Claim Class PA Appr ID# VIN Year Make Model Body Style 2DR 4DR Hatchback Convertible Wagon Pickup Van Utility ½ Ton ¾ Ton 1 Ton Shor.

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