Glass Form #2
Print this page, Fill it out,
Then fax it back to:
201.843.3238
To service you correctly we need the following information:

INQUIRIES/ORDERS

Your Name_____________________________________________________

Phone #______________________________________

Fax #________________________________________

e-mail_______________________________________

Make Of Vehicle___________________Year________Model______________

Vehicle Manufacturing Date_______________________________________

INDICATE ON EACH PIECE OF GLASS WHERE THE LOGO & DATE IS LOCATED