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1800 686 693

1800 686 693

24Hr Fast Glass Replacement

1800 686 693

Glass Replacement Order Form

To complete the booking process we require some additional information from you. Please complete the details below and submit. All fields marked with an asterisk (*) are mandatory.

Customer Details

Contact Details

Address

Appointment Details

Insurance Details

Privacy Policy Regarding Service Requests

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

By clicking 'Submit' you confirm that you have read and agree to the terms of our privacy policy. Unless you have unticked the appropriate box above to decline, by clicking 'Submit' you are also consenting to receive marketing messages (by mail, email and telephone) about related services which may be of interest to you.

Please complete all the mandatory fields before clicking submit