Intercity Auto: eGlassClaim

MPI eGlassClaim

Let’s make your next Glass Claim Reporting that much easier. Please fill out the following to report your MPI eGlassClaim. You will be contacted in a timely manner to confirm claim number, date and time of your appointment.

Plate Number:
Date of Loss:
First & Last Name:
Company:
Address:
City:
Province:
Postal Code:
Phone:
Cell:
Alternate Phone:
E-mail:
	Vehicle Information
Year:
Make:
Model:
Tinted:
VIN:
Licence Document Number (Numerical code found on middle section beside picture of One Piece I.D. OR bottom right on BLUE Paper portion on Two Piece I.D.)

What caused the damage to the vehicle?

Where was the incident site? (e.g. parking lot, street, highway, etc.)

Glass Type: (e.g. windshield, side passenger, rear window, etc.)

Additional Notes