AGENT SUBMISSION Submit your client’s insurance claim information directly to Michigan ADAS Calibrations & Glass, LLC. 1Client Info2Insurance/Vehicle Info3Additional Info4Agent Info Client's Name Client's Address Client's Phone # Email Policy # Policy Type Person Business Other If Other, What Kind of Policy Vehicle # Deductible Date of Loss Next Agency Agency Phone # Insurance Company VIN Year Make Model PreviousNext Glass Needed Front Shield Back Glass Driver's Side Door Passenger's Side Door Other Attach any necessary images/documents Additional Notes PreviousNext Name Email Previous Send
