Agent Form

Insurance Agent Form For Alamance Glass Inc.

For Insurance Agency Use Only

If you’re looking for a quote, click here to fill out our convenient form or call us today at 336-227-6694.

Insurance Agents:

If your clients need glass work done, fill out our convenient form below. One of our dedicated customer service representatives will contact them directly.

Vehicle*

Vehicle Year

Vehicle Make

Vehicle Model

Damaged Glass*

Service Postal Code*

ZIP Code

Policyholder Name*

First Name

Last Name

Policyholder Phone*

Policyholder Email

Insurer

No Coverage

Deductible

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!

Agency & Additional Notes

We’d love to hear from you! Call our friendly team at 336-227-6694.

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Contact Information

Phone:

(336) 227-6694

Address:

202 Alamance Rd

Burlington, NC 27215