Windshield Claim Form

Fields marked with * are required fields.

  • Step 1 - Personal Contact Information

  • By providing your email address, you agree to receive claim documents electronically.
  • Step 2 - Vehicle Information

  • Example: Mercedes, Porsche, Toyota, Chevrolet, Honda, etc.
  • Example: Prius, C Class, Boxter, Impala, Accord, etc.
  • Step 4 - Claim Description Information

  • (please be as specific as possible)
  • WindshieldZones
  • Step 5 - Acceptance and Submission

  • Please type your initials to indicate: I am aware that PermaPlate Company LLC, Inc. relies on the information and statements above. I hereby certify that the above statements are complete and accurate to the best of my knowledge. Any fraudulent statements will result in invalidity of warranty.
  • This field is for validation purposes and should be left unchanged.