Request to Register – Vehicle Glass Claims

Please complete this form so that we can register your claim with the insurer. We may require further details from you and will be in contact if needed.

    Is this a Chip repair of a full replacement?*
    Chip RepairFull Replacement

    Which vehicle glass is damaged?*

    Completion of this form does not mean that your claim is registered. We will use this information to do the registration for you with your insurer. You will then be notified of your claim number and what to do next.


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