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Wholesale Fleet Submission Form

Please contact us if you have a fleet. We can service your company in all of its auto glass needs.

We have windshield replacement centers through all of Minnesota. We also have an auto glass mobile service which can go to your specific location.

Fields with an are required and must be filled-in to process the form.
Simply fill in the blanks and click the "Submit" button.

Submit a claim to: fleetreq@harmonglassmn.com

Fleet Information

Company Name:

Company Address:

City:

State

Phone:

Insurance Information - If Applicable

Insurance Company:

Agency:

Policy Number:

Claim Number:

Deductable:

Cause of Loss:

Date of Loss:

Network Ref Number:

Vehicle Information

Year:

Make:

Model:

VIN:

Which glass is broken: Front/Back/Side?

Comments:

Submitted By:

Phone Number:

Email Address:

Form Security:

Security Code:

Enter code:

Auto Glass Intalling Confidence

A name that means quality…
A name that you can trust!