CLAIM FORM Please fill out the claim form below to submit your claim. Check our FAQs for questions you may have . If you can’t find your answer, then please contact us before submitting this claim. CLAIM DATE CARRIER REFERRAL TYPE*: RESTORATIONMITIGATIONAPPRAISAL INSURED/RESIDENT INFORMATION: FIRST & LAST NAME* ADDRESS* DAY TIME PHONE NUMBER* EVENING PHONE NUMBER EMAIL OWNER INFORMATION: SAME AS ABOVE OWNER'S FIRST & LAST NAME OWNER'S ADDRESS DAY TIME PHONE NUMBER EVENING PHONE NUMBER OWNER'S EMAIL POLICY INFORMATION: CLAIM REFERENCE NUMBER POLICY NUMBER DEDUCTIBLE AMOUNT POLICY LIMITS: DWELLING CONTENTS OTHER LOSS INFORMATION: LOSS DATE LOSS TYPE (YOU CAN CHOOSE MULTIPLE TYPES BY HOLDING CTRL KEY) --- Water or Steam Sewer or Drain Backup Mold Fire Flood Freezing Mechanical Breakdown Ice or Snow Weight Non-Emergency Repair Other Casualty Losses Hurricane Test Project Animal Liability Aircraft Burglary Collapse Collision Contamination or Pollution Earthquake Explosion Falling Object Glass Hail Heat Expansion or Contraction Land Slide Lightning Mud Slide Moving and Storage Mysterious Disappearance Power Interruption Power Surge Riot Robbery Sea Water Sinkhole or Collapse Smoke Subsidence Theft Tornado Trauma Vandalism or Malicious Mischief Vehicle Volcanic Windstorm All Water Causes Smoke / Fire Damage Environmental (Mold / Asbestos) Sump Pump overflow Other ADDITIONAL INFORMATION ABOUT THE LOSS SPECIAL INSTRUCTIONS ADJUSTER'S INFORMATION: ADJUSTER'S FIRST & LAST NAME INDEPENDENT ADJUSTER EMAIL ADDRESS TO SEND THE CONFIRMATION TO UPLOAD YOUR FILE HERE (IF NEEDED, MAX SIZE IS 10 MB) BY SUBMITTING THIS CLAIM FORM, I CONFIRM THAT ALL THE INFORMATION PROVIDED ABOVE ARE ACCURATE.* PROUDLY BASED IN DAYTON, OHIO But our service area covers 75 miles around Dayton! Call us now 937-223-5555 © 2021 All Serv Restoration. Web Development & Graphic Design by LOYABILITY with

FAQ FREQUENTLY ASKED QUESTIONS ABOUT FIRE AND SMOKE DAMAGE FREQUENTLY ASKED QUESTIONS ABOUT HOME INSURANCE CLAIMS FREQUENTLY ASKED QUESTIONS ABOUT WATER DAMAGE FREQUENTLY ASKED QUESTIONS ABOUT MOLD PROUDLY BASED IN DAYTON, OHIO But our service area covers 75 miles around Dayton! Call us now 937-223-5555 © 2021 All Serv Restoration. Web Development & Graphic Design by LOYABILITY with