Please complete the form and click on the “Submit” button. We will contact the policy holder within one hour.

For immediate service, please contact us at: 800-538-4719

We work with all insurance companies to process claims in a timely manner.
Here is what one of the local insurance agents has to say about the services they received………

“Thank you so much for all your help on this claim. Our client spoke very highly of you. You are one of the reasons we are using your company as the service has been amazing. We have been approached by numerous glass companies lately and have turned them down as we are very pleased with the service our clients are receiving from Ideal. Thank you again and keep up the great work!”

Note: Fields marked with an asterisk (*) are required.

Policy Holder Information

*Name:

*Address:

*City:

*State:

*Zip:

*Day Phone:

Other Phone:

Email:

Policy Information

*Insurance Company:

*Agency:

*Policy Number:

Claim Number:

Deductible:

Cause of loss:

Date of loss:

Referral/Dispatch#:

Vehicle Information

*Year:

*Make:

*Model:

VIN#:

Doors: 2 Door4 Door

Select which glass is broken:

Other:

Submitted By

*Submitted by Name:

*Phone:

*Email:

*Sales Representative: DanWesNickMarc

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