Agent Portal

AGENT INFORMATION
Order Sent By
Your Email
Your Agency Name
Your Phone
North Georgia Auto Glass Sales Rep
CUSTOMER INFORMATION
Customer Name: First
Last
Customer Street Address
City
State
Zip Code
Customer Phone
Customer Email
INSURANCE INFORMATION
Insurance Company
Policy/Claim Number
Insurance Coverage Verified?
- Yes
- No
Date of Loss
Deductible Amount
VEHICLE INFORMATION
Vehicle Identification Number (VIN)
Year
Make
Model
Vehicle Type
- 2-Door
- 4-Door
SERVICE INFORMATION
- Windshield
- Drivers Side Front Door Glass
- Passenger Side Front Door Glass
- Passenger Side Rear Door Glass
- Pick-up Truck Sliding Back Glass
- Drivers Side Rear Vent Glass
- Windshield Repair
- Drivers Side Quarter Glass
- Passenger Side Quarter Glass
- Drivers Side Rear Door Glass
- Back Glass
- Passenger Side Rear Vent Glass
ADDITIONAL INFORMATION
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AGENT INFORMATION