1800 686 693
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First Name *
Last Name *
State*---ACTNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia
Preferred Time---7AM to 12PM12PM to 5PMNow
Service Required---Glass ReplacementArchitectural GlassCommercial WindowsOther
Description of work to be done
Contact me by---Phone or EmailPhoneEmail
Would you like us to bill your Insurance Company?---YesNo
Cause of Damage---Accidental impactBreak & enterCleaning/repairsDeliberate breakageFound brokenThermal breakageVandalism/malicious damageWeather relatedOtherNot known
When you submit a service request through GlassNow.com.au, any information we request is used to process your order and if necessary, to contact you for help when we are processing an order. You also may receive a phone call and e-mail after our service is complete. All information we collect is stored in a secure database. As a GlassNow™ customer, your billing, email & phone info will not be rented or sold. However, we may use it to send you marketing messages (by mail, email and telephone) about related services which may be of interest to you.
Would you like to receive promotional emails & newsletters from us: Yes
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