Agent Claim Form

Help Your Customer Get Their Auto Glass Taken Care Of

When your customer needs auto glass repair or replacement, Cornerstone makes it easy to send them our way.

We work with insurance agents and carriers to make auto glass insurance claims easier for their customers. Cornerstone works with all insurance companies, is on every auto glass billing company’s approved list, and can assist customers with policies issued both in and outside Colorado.

Use the Agent Claim Form below to send us the customer, vehicle, insurance, and damage information we need to get started. Once we receive it, we’ll review the information and contact your customer about their auto glass service.

We’ve been serving the Denver Metro and foothills area for over 25 years with our shop location and our mobile service vehicles.

Agent Claim Form

Customer Information

Customer Name

Phone Number

Email Address

Customer Address

Vehicle Information

Year

Make

Model

Body Style

VIN

Insurance & Claim Information

Insurance Company

Policy Number

Date of Damage/Loss

Auto Glass Damage

Which glass is damaged?

What caused the damage?

Rock Hail Other

If Other, please describe

Is the damaged area small enough to be completely covered by a dollar coin?

Yes No Not Sure

Photos of the Damage (optional)

Was there any other vehicle damage associated with the loss?

Yes No Not Sure

If Yes, please briefly describe

Agent Information

Agent Name

Agent Phone Number

Agent Email Address

Additional Information

Is there anything else we should know about the customer, vehicle, claim, or damage?

An Auto Glass Partner You Can Send Your Customers To

A referral reflects on your agency, too.

When you send a customer to Cornerstone, they’ll work with experienced auto glass professionals who take the time to explain what their vehicle needs and why. Our technicians are individually AGSC and Sika certified through testing, and we approach every job with the same commitment to safety, craftsmanship, and doing the work correctly.

Cornerstone has served Colorado drivers since 2001, and we value the relationships we’ve built with insurance professionals who trust us with their customers.

Have a question before submitting a claim?