Auto Glass Insurance Claim

Auto Glass Insurance Claim Updated

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For Jack's Glass to work with your insurance for auto glass repair or replacement, we need certain information to help coordinate the repair. Please either submit an image of your insurance card or complete the form fields below to help start the process.

Upload Insurance Card or Submit Information*

Upload Insurance Card

Submit Information

Upload An Image Of Your Insurance Card*

Accepted file types: jpg, png, , heic, pdf, gif, hevc, Max. file size: 256 MB.

Vehicle Year*

Vehicle Make*

Vehicle Model*

VIN (Optional)

Damaged Glass*

Zip Code*

Policyholder Name*

Policyholder Phone Number*

Auto Insurance Provider*

Policy #*

Notes (Optional)

If a claim has already been submitted, please include the reference number in the Notes section. We will contact the policyholder shortly to help coordinate scheduling for their glass repair. For immediate questions, you can call Jack's Glass at 859-342-5225.