Auto Glass Only Submission Form

  • Have you experienced damage to your auto that is contained to only glass? Many insurance carriers contract directly with Safelite Auto Glass to expedite your claim. With only your policy number, you are able to file a claim and schedule an appointment at the same time. Check out their company website at If you would like to use another glass repair shop or need any assistance, please complete the below InterWest form. A property and casualty claims professional will contact you as soon as possible but not more than 1 business day. Let our experience guide you!
  • Incident Information

  • Date Format: MM slash DD slash YYYY
  • :
  • Insured Vehicle and Driver Information

  • Please attach a copy of photos or any other information related to this incident.
  • Drop files here or