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ALT ROOFING EVALUATION CUSTOMER INFORMATION Customer: Insurance Co. Control : RR0987654 Cust. ID: INSCO0001 Date Rcvd: 6/4/2009 Date Inv: 6/3/2009 Add Cust: Adjuster: Jane Adjuster Rep: Adjuster Fax: 800-123-4567 INSURED INFORMATION Claim #: 0123456789 Loss Date: 6/1/2009 Insured Name : John Insured Area Damaged: Front roof slope City, State, Zip: Anytown, MN 12345 Original Product Brand/Type Discontinued Line Color Warranty NationalBrand / Architectural (Metric) King Honey B.

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