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Step 1: Policyholder’s Information

*Required Fields.
Preferred Method Of Contact *
The “mobile” option for phone number must be selected to receive texts from Portland Glass.

By choosing text, I opt in to agree to receive automated SMS and/or MMS message from Portland Glass, a Neighborly company, to the provided mobile number(s). Message & data rates may apply. View Terms and Privacy Policy . Reply STOP to opt out of future messages.

This field is required

Step 2: Insurance Information


Portland Glass will assist the insured through the process of calling the network associated with the insurance company to help obtain this information.


Step 3: Vehicle Information


Glass to be replaced/repaired:
Please select one or more items you would like to be replaced or repaired.












Step 4: Agency Information



Step 5: Anything Else We Should Know?




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