Submit A Claim

Making a Claim

We will collect basic info To get Your Claim Started

When you choose Carefree Windshield Repair, you will get a stress-free service. We will not only repair, replace, & calibrate your vehicle but also manage your insurance claim from start to finish.

We will now collect basic info to verify your insurance deductible and coverage.

Insurance Provider

Policy Number

Best number to reach you

When did the damage occur?

How did the damage occur?

In which city did the damage occur?

In which state did the damage occur?

Year

Make

Model

Color

VIN

Policyholder First name

Policyholder Last name

Email address

Street address

City

State

Policy Zip Code

Which glass was damaged?

Windshield Back Glass Driver Side Glass Passenger's Side Glass

Replace or Repair

How many chips are we repairing

Driver Side: Choose One

Passenger's Side: Choose One

Authorization to Submit Claims:

I hereby assign all insurance benefits, rights, and proceeds under my policy of insurance to Carefree Windshield Repair Inc. for services rendered in connection with the repair and/or replacement of my vehicle's windshield. This assignment includes, but is not limited to, the right to receive any and all insurance payments, benefits, and proceeds due to me under my insurance policy. Carefree Windshield Repair Inc is authorized to submit insurance claims, receive payments, and negotiate with my insurance company on my behalf. Authorization to Submit Claims: I hereby authorize Carefree Windshield Repair Inc. to submit claims on my behalf to my insurance company for the services provided. This includes, but is not limited to, providing necessary documentation, communications, and follow-up related to the claim process. I understand that by executing this Assignment of Benefits, I am transferring my rights to insurance benefits to Carefree Windshield Repair Inc. and that this assignment is irrevocable.

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Making a Claim

We will collect basic info To get Your Claim Started

Submit A Claim

Making a Claim

We will collect basic info To get Your Claim Started

Submit A Claim

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