Customer Details

Last Name (required)

Company Name

Contact Details

Phone Number (required)

Location

Suburb (required)

Postcode

Appointment Details

Preferred Time
—Please choose an option—7AM to 12PM12PM to 5PMNow

Service Required (required)
—Please choose an option—Glass ReplacementPet DoorsShower ScreensCommercial WindowsMirrors and SplashbacksTabletopsArchitectural GlassGlass Compliance AuditsOther

Contact me by (required)
—Please choose an option—Phone & emailPhoneEmail

Urgency of Job Required? (required)
—Please choose an option—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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