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Five Star Adjusting
Company Name *
Company Address *
City/State/Province *
Zip Code *
Adjuster's Name *
Adjuster's Phone *
Adjuster's Email *
Adjuster's Fax
Company Information
Loss Information
Claim Number *
Date Assigned *
Instructions
Insured Information
Insured Name
Street Address
City and State/Province
Zip Code
Phone Number
Alternate Phone
Loss Location
Policy Number
Coverage A
Coverage B
Coverage C
Coverage D
Deductible
Akron, OH- Headquarters
P.O. Box 26051
Akron, OH 44319
Office (330)470-1022
Fax (888)345-STAR
Instructions
Claimant Information
Claimant Name
Street Address
City and State/Province
Zip Code
Phone Number
Alternate Phone
Loss Location
Instructions
Appraisal
Insured
Vehicle Owner
VIN Number
Vehicle Location
City and State/Province
Zip Code
Phone Number
Alternate Phone
* Required Field
Instructions
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