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Easy Order
Glass Specialty's Easy Order is a simple way for insurance providers to submit jobs to Glass Specialty.

  1. Fill out the fields below.
  2. Click Submit.
  3. Glass Specialty will contact your policyholder and schedule service.

    If you have any questions about the process,
    please call 1-800-851-6862.

    Easy Order Program Summary - CLICK HERE (PDF)

    Thank you for choosing Glass Specialty!

CUSTOMER INFORMATION
Policyholder Name:
Address:
City:
State:
Zip:
Home Phone:
Cell Phone:
Work Phone:  Ext:
Contact Customer:
Home Cell Work
 
INSURANCE INFORMATION
Agency Name:
Agent:
Agent Phone:
Submitted By:
Address:
City:
State:
Zip:
Insurance Carrier :
Policy Number:
Deductible:
Date of Loss:
Notes:
 
VEHICLE INFORMATION
VIN Number :
Year:
Make:
Model:
Vehicle Type:
2DR 4DR Hatch Other
Windshield
Replace or Repair:
Replacement Repair
Other Parts:
Back Glass Door Glass Other
 
CATEGORY ASSIGNMENT
Agency
Insured
HDA
CE U
Not Applicable
 
REQUIRED INFORMATION
Your Email Address: