WHITE MOUNTAIN SURVEY CO., INC.
1270 ROUTE 16, POST OFFICE BOX 440
OSSIPEE, NH 03864-0440
TELEPHONE (603) 539-4118 FACSIMILE (603) 539-7912
www.whitemountainsurvey.com

WMSC DATA REQUEST FORM:
PLEASE FILL IN ALL INFORMATION AND SUBMITT ELECTRONICALLY WITH THE BUTTON AT THE BOTTOM OF THE PAGE.

DATE:  

TO: 

PROJECT NAME:

SUBJECT: 

FROM:  

PHONE:

EMAIL:

FILE NUMBER: 

As requested, we will prepare a CD or e-mail for the requested drawing files. However prior to
its release, we need you to review, agree, sign (entering your name below shall constitute your
your signature) and submit this form.

COMPANY NAME ("I" In the agreement below):

MAILING ADDRESS:

TELEPHONE:

FAX: 

PRIMARY CONTACT:

EMAIL:

PROJECT: 

ROLE IN THIS PROJECT. DATA WILL BE USED FOR WHAT PURPOSE?

IN CONSIDERATION FOR RECEIVING DATA FOR THE ABOVE NAMED PROJECT, I UNDERSTAND THAT THIS DATA
IS CHANGEABLE DATA, MADE AVAILABLE FOR MY CONVENIENCE. I UNDERSTAND THAT I UTILIZE THE DATA AT
AT MY OWN RISK, AND THAT ONLY STAMPED PLANS, REVIEWED AND SIGNED BY THE ENGINEER/SURVEYOR
REPRESENT DESIGNS ABLE TO BE REFERENCED FOR CONSTRUCTION PURPOSES, AND THEY SERVE AS THE
CONTROL DOCUMENTS AGAINST WHICH CHANGEABLE CAD DATA SHOULD BE PERIODICALLY VERIFIED. IN ADD-
ITION, I AGREE TO TAKE ALL PREVENTATIVE MEASURES TO INSURE THAT THE DATA I RECEIVE, OR ANY PART
THEREOF, DOES NOT ECOME TRANSMITTED TO OTHER PARTIES IN ANY ORIGINAL OR EDITIED FORM, OR USED
ON OTHER PROJECTS WITHOUT PRIOR WRITTEN CONSENT. I INDEMNIFY WHITE MOUNTAIN SURVEY CO., INC., FOR
MY USE OF SAID DATA. I AGREE TO COMPENSATE WHITE MOUNTAIN SURVEY CO., INC. FOR ANY COST ASSOC-
IATED WITH THE PREPARATION OF THIS INFORMATION.

AGREED BY:

DATE:   

TITLE: