Your Name (required)

Insurance Company (required)

Policy Number (required)

VIN Number (required)

Customer Phone Number (required)

Agency Name

Contact Name

Agency Phone Number

Your Email (required)

Special Instructions

How it Works:

1.) Please fill out all information.

2.) Click “Submit Form” and your order will automatically be sent to a WISCONSIN WINDSHIELD CENTERS claims expert.

3.) We will contact your customer within 15 minutes and connect them, by “3-way”, to the appropriate claim reporting center.

4.) We will assist them in the claim process.

5.) We will set up an appointment between 6 a.m. and 6 p.m. Monday through Friday, or between 7 a.m. and 4 p.m. on Saturdays.

6.) We will call you back and confirm reciept of the “Glass Claim Report”.

It’s that simple!

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