Glass Form #1
Print this page, Fill it out,
Then fax it back to:
201.843.3238
To service you correctly we need the following information:
Check all that apply

INQUIRIES/ORDERS

Your Name_____________________________________________________

Phone # or e-mail________________________________________________

STEP 1. MAKE OF VEHICLE____________,YEAR_______MODEL___________


STEP 2. TYPE 2/DR___4/DR___HT___SEDAN___CONV.___OTHER___

STEP 3.

1. ONE PIECE WINDSHIELD___W/ANTENNA___
   
2. SPLIT WINDSHIELD L___R___PAIR___
   
3. VENT(S) L___R___PAIR___
   
4. DOOR(S) L___R___PAIR___
   
5. QTR.(S) L___R___PAIR___
   
6. BK.GLASS W/HEAT___ OR WO/HEAT___
   

STEP 4.

1. DO YOU WANT CLEAR___TINTED___OR WHATEVER IS AVAILABLE___
   
   WINDSHIELDS CLEAR___TINTED___TINT SHADED___
   

STEP 5. DO YOU WANT LOGOS & DATE CODES YES__NO__

TYPICAL LOGOS & DATE CODES