Auto Glass Insurance Claim

"*" indicates required fields

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.