Contact Information Your Business Name * Your Name * Shipping Address
Contact Number * Fax Quote Confirmation Email *
Website Is this a residential address? Billing same as Shipping? Billing Address
Contact Number * Fax How did you hear about us? * -- Email Flyer Existing Customer Internet Ad Internet Search Logo On Windshield Magazine Ad: (please specify) Referral: (please specify) Tradeshow: (please specify) Other: (please specify)
Please specify: * Billing Email *
Product Application Information Which application are you inquiring about? * -- RV or Towable Fire Apparatus Charter Bus or Motorcoach School Bus Transit Rail Heavy Equipment Medical Other Product Needed * -- One-piece Windshield Driver-side Windshield Passenger-side Windshield Both Driver and Passenger-side Windshield Back Glass Gasket Molding Side Glass Vehicle Information Year * Make
*Required for all vehicles except RVs or towables.
Model * Part # Quantity Needed VIN Window Information Window Side * -- Driver's Side Passenger Side Rear Cab Window Location * -- Pilot Co-Pilot Living Dining Bedroom Kitchen Bath Quote For: * -- Glass Only Complete Window Glass Information All #'s on Windshield Glass Manufacturer DOT #
Glass Size Height (in inches) Width (in inches) Does your windshield have ceramic? Does your windshield have a shade band?
Installation Method -- Gasket Glue-In Flush Mount Unknown Frame Information Frame Color -- Black Brown Polar White Other Glass Color * -- Lt. Gray Dk Gray Bronze Green Privacy/Reflective Clear Other Measurements Glass Height * Glass Width * Frame Height Frame Width
Is this an emergency exit? Glass Movement * -- Solid/Fixed Horizontal Sliding Vertical Sliding Crank-Out/Torque Glass Pane * -- Single Dual Frame/Glass Corners -- Radius/Rounded Mitered/Cornered Other Hidden Additional Information Additional Information
If you need additional windows, please provide the Side and Location information in the additional information field below.
Hidden Photo Submission
Providing photos can be very helpful in identifying your replacement glass. For windshield glass, please use the examples below to capture a front and 45 degree angle view of the vehicle. Be sure to include the entire vehicle in the frame as shown in the examples below:
1. Full front of the vehicle, straight on
2. 45 degree angle from the front of the vehicle. Please include both passenger and driver sides for one-piece and only the side affected for a two piece shield.
For side glass, please capture the vehicle squarely from each side and from the rear. If the window being replaced is on the side wall of a slide room, please also photograph the vehicle with the room in the extended position, so the window is in full view (6). Include the entire vehicle in the frame, as shown in the examples below:
3. Driver side view
4. Passenger side view
5. Rear of the vehicle, straight on
6. 45 degree angle from front or rear to show slide room window(s)
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