Agent - Mass Auto Glass

Agent FormMass Auto Glass

FOR INSURANCE AGENCY USE ONLY

Insurance Agents – Please complete the Agent Form below in order to let us know that your client needs glass work done. An Mass Auto Glass customer service representative will then contact your client and take care of everything.

Insurance Agency Name

Vehicle Year

Vehicle Make

Vehicle Model

VIN

Damaged Glass

Policyholder Name

Policyholder Email

Insurer

Policy Number

Deductible

Reference Number (optional)

If a claim has already been filed please include the reference number above. We will contact the policyholder as soon as possible to coordinate scheduling for their glass service. Thank you!

An Mass Auto Glass representative will contact your customer shortly. Thank you for your business.

Agent FormMass Auto Glass

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