Data Request Form

1. First Name *This question is required.

2. Last Name *This question is required.

3. Email *This question is required. This question requires a valid email address.

4. Please select one of the following options: *This question is required.

5. If you want to designate an authorized agent, upload a signed letter designating an agent below, and indicate the agent's name in the field below. You may also send the authorized agent's name and a copy of the signed letter to privacy@haascnc.com.

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6. Authorized Agent's Name (if applicable):

7. Additional Comments

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