Customer Name (required)

Policy Number (required)

Customer Phone Number (required)

Agency Name

Contact Name

Agency Phone Number

Agent Email

Special Instructions

How it Works:

1.) Please fill out all information.

2.) Click “Submit Form” and your order will automatically be sent to a WINDSHIELD CENTERS claims expert.

3.) We will contact your customer within 15 minutes and connect them, by “3-way”, to the appropriate claim reporting center.

4.) We will assist them in the claim process.

5.) We will set up an appointment between 6 a.m. and 6 p.m. Monday through Friday, or between 7 a.m. and 4 p.m. on Saturdays.

6.) We will call you back and confirm reciept of the “Glass Claim Report”.

It’s that simple!

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