Auto Glass Claim – Tartan Insurance Agency, Inc.

Fields marked with * are required

Your Name*

Your Email*

Phone Number*

Policy Number*

Date of Claim*

Vehicle Year*

Vehicle Make & Model*

Which Glass is Damaged (Select all that Apply)

Front Windshield
Rear Windshield
Driver-Side Front Window
Passenger-Side Front Window
Driver-Side Rear Window
Passenger-Side Rear Window
Vent Window (Small Door Window)
Sun Roof
Other

Please Describe how the Damage Happened*