Insurance Claim Submission Form

You can now submit insurance claim information directly to our shop online. We'll take the information, set up an appointment and contact you and your insurance company. To start, just fill out the form below. When we receive the information, we'll call you to confirm and then set up an appointment. If you'd like to speak with someone directly, feel free to call us at (888) 228 - 0686.

Customer Information: Vehicle Information:
Name: Year:
Address: Make:
City: Model:
State: Body Style:
Zip Code: VIN Number:
Home Phone: Damaged Glass:
Work Phone:    
Cell Phone:    
       
Insurance Information:
Ins. Company: Agency:
Policy#: Sent By:
Comp Coverage:  Yes    No Deductible:
Date of Loss: Cause of Loss:
       
Are there any special instructions?
   
   
   
       
      

Auto Glass of New England provides Windshield Repair and Auto Glass Replacement services from their
locations in Stratford, Naugatuck, Danbury and Hamden. Mobile Auto Glass Services are available throughout Connecticut. Credit cards accepted.

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