Customer Name: *Required
 Home Phone Number: - - *Required
 Work Phone Number: - -
 Cell Number: - -
 Email: *Required
 State: * Required
 Address on Policy : *Required
 Insurance Company : *Required
 Policy Number : *Required
 17 Digit VIN Number :
Agency Name & Phone Number :
 Vehicle Information
 Make: ie) Chevrolet
 Model: ie) Silverado C3500
 Style: ie) 4 Door Crew Cab
 Year:
 Damage Information
 The piece of glass damaged is the: Windshield   Rear Glass
 Side Glass    Other
Date of Loss :
Cause :
Full Glass :
Deductible Amount :
 Additional Information:

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OUR LOCATIONS

Novus Washington

Greater Seattle 206 957 0995
Greater Tacoma 206 244 2465
Olympia 360 413 9902
Burien 206 244 2465
Renton 425 793 9724
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Kirkland 425 821 7429
Bellevue 425 643 1992
Issaquah 425 391 7971

Novus Arizona

Phoenix 602 843 9682
Tempe 602 843 9682
Tucson 520 620 6077

Novus Alaska

Anchorage 907 277 3464
Fairbanks 907 456 6301