Insurance Claim Form

Complete Your Insurance Claim Form. Please complete all information below. Once the form is submitted a representive will contact you soon to schedule a time for the auto glass repair or replacement.

Insurance Company

Policy #

Name of Insured

Address

City

State

Zip

Phone

Vehicle

Year

Make

Model

VIN

Please describe which glass is broken and how it was broken

Date glass was broken

Contact Name (if different from above)

Contact Phone (if different from above)

AGF is proud to be a preferred dealer for the following insurance companies and claims administrators:

Allstate
Nationwide
Geico
Progressive Auto Owners Liberty Mutual
Safelite Autoglass
Lynx Services
Gerber National
Harmon Solutions
Duncan Systems
Guardian Glass
Net Cost