Insurance Information



Submit a Claim

Please complete the information on the form and Submit. We will promptly contact your insured and do whatever necessary to process the auto glass claim for you.

Insurance Information * Required fields
 
*Insurance Company
 
*Policy # Insurance Agent/Agency
 
Agency Phone # Comprehensive Deductible
 
 
Policyholder Information
 
 
*Insured Last Name *Insured First Name
 
Address
 
*City *State
 
*Zip: *(Sender's)Email Address
 
*Best Day Telephone *Best Evening Telephone
() - () -
 
 
Accident Information
 
*Date Damage Occurred (ex:09/01/2007) *Cause of Damage
Show Calendar
 
Glass Damage *Who Was Driving?
 
 
Vehicle Information
 
*Year *Make
 
*Model Vehicle Identification Number (VIN)
 
If work has already been done and you have the invoice,
please fax the invoice to 800-981-9891.
 
Comments
Note: Submitting a claim in no way denies or guarantees insurance coverage of your auto glass loss. After receiving your claim, we will take steps to determine if coverage exists. We will then contact you to schedule service with a convenient auto glass vendor.
Thank you for using our online claim service!
Safelite can help

Safelite can help!

Having a damaged car window is an unexpected and unwelcome event, but you're at the right place.

Safelite AutoGlass has been the trusted expert in the auto glass business for more than 60 years and we serve nearly 4 million customers each year.

 

We're here

We're here when you need us.

You can contact Safelite 24 hours a day, 365 days a year to schedule auto glass service, get a quote, or discuss your flexible payment options.