Customer Details

Company Name



Contact Details

Phone Number (required)



Location

Suburb (required)

Postcode (required)



Appointment Details

Preferred Time
---7AM to 12PM12PM to 5PMNow

Service Required (required)
---General EnquiryGlass ReplacementArchitectural GlassCommercial WindowsOther

Contact me by (required)
---Phone & emailPhoneEmail

Urgency of Job Required? (required)
---NowNot so urgentAnytime

Description of work to be done
Please provide as much information as possible and photos i.e. broken window approximately 800 x 700 or pet door installed into door approximately 2000 x 1000

Upload up to 3 photos or documents

I would like to receive promotional emails & newsletters
YesNo

I have read and agree to the terms of the GlassNow™ privacy policy
Yes

Please note we DO NOT replace or repair windscreens or vehicle glass.

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