Auto Glass Insurance Claim Auto Glass Insurance Claim Updated "*" indicates required fields 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*Select Vehicle Year20252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949Vehicle Make*Select MakeAbarthAcuraAlfa RomeoAston MartinAudiBentleyBMWBuickCadillacChevroletChryslerCitroenDaciaDodgeFerrariFiatFordGMCHondaHummerHyundaiInfinitiIsuzuJaguarJeepKiaLamborghiniLanciaLand RoverLexusLincolnLotusMaseratiMazdaMercedes-BenzMercuryMiniMitsubishiNissanOpelPeugeotPontiacPorscheRamRenaultSaabSaturnScionSeatSkodaSmartSubaruSuzukiTeslaToyotaVolkswagenVolvoWiesmannOther (List In Notes)Vehicle Model* VIN (Optional) Damaged Glass*Front WindshieldDoor - Front DriverDoor - Front PassengerDoor - Rear DriverDoor - Rear PassengerQuarterVentRearZip Code* Policyholder Name* Policyholder Phone Number*Auto Insurance Provider*Select Provider21st CenturyAAAAllstateAmerican FamilyAmicaAuto-OwnersChubbConnectCountry FinancialDairylandDirect AutoEncompassErieFarm BureauFarmersGeicoThe GeneralGeorgia Farm BureauGood2GoThe HanoverThe HartfordInfinityLiberty MutualMapfreMercuryMetlifeMetromileNationwideNJMProgressiveRootSafe AutoSafecoShelterState AutoState FarmTexas Farm BureauTravelersUSAAOther (List In Notes)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. Δ