CHEQUE

YOUR NAMEYour AddressYour City, Your State, Zip Code

pay to the order of $

dollars

signature

date

5552-5264582536-14514558

&Read Claim Form InstructionsComplete Claim Form

Do I Have theRight Brand

of Vermiculite?

1. Receipt ofZonolite Purchase

3 Ways of Providing Payment:

1. 3 Sets of Before/After Pictures(Before Removal, After Removal but BeforeRe-insulation, and After Re-insulation)

Await Review of Your Claim

ZAI

©2018 Zonolite Attic Insulation Trust

Step 1

How To File A Claim

2. Original Bag Photos(Multiple Photos of Original Bag Inside A�ic With Bag Declaration Form) or Send in Original Bag3. Submitting a Sample(See Sampling Instructions)

3 Ways:

Submit All of the Following:

2. Provide Contractors Proposaland Final Invoice3. Provide Proof of Payment (3 Ways)

1. Front & Back of Cancelled Check(If Paid With Check)

2. Front of the Check and its Corresponding Bank Statement

3. Credit Card Statement ShowingAccountholder’s Name and Transaction(If Paid With Credit Card)

You Will BeContactedDuring This Process

www.zaitrust.com 844-ZAI-CALL

YES

Step 2

Step 3

Step 4

The Trust Reserves the Right to Request Additional Evidence that it Deems Necessary to Establish a Valid Claim