Please fill out this form completely so that we may contact you with an estimate.

Contact Information:

Name:
Home Address:
City	State
Zip Code:
Your e-mail Address:
Home Phone:
Work Phone:	(if none, type "none")
Preferred Date of Installation:

About Your Vehicle:

Year
Make (ie; Toyota, Honda, Ford,etc.)
Model (ie; Tercel, Accord, Mustang, etc.)
Door

Parts Required:

Choose the parts you need below:

Windshield	Windshield Repair
Driver's Front Door	Passenger's Front Door
Driver Front Door Vent	Passenger Front Door Vent
Driver Side Rear Door	Passenger Side Rear Door
Driver Side Rear Door Vent	Passenger Side Rear Door Vent
Driver Side Quarter	Passenger Side Quarter
Backglass	Other

Many times the part your vehicle needs varies with vehicle "options." Following is a list of vehicle options which could affect the part you need. Please select any which apply.

Antenna in windshield	Rear Defroster	Privacy Glass
Heads Up Display	Vinyl Roof	Hatchback
Heated Windshield	Sliding/Moveable	Sedan
Sunroof	Rear Wiper	Extended Cab (truck)
Overhead Console	Antenna in Backglass	Crew Cab (truck)
Other Options

Number of Doors 2 3 4 5

What color tinting is the glass in your vehicle? (You can check this by holding a piece of white paper up behind an open door window. Nearly all vehicles have tinted glass today - Clear glass is usually MORE expensive)  green blue bronze grey clear

If you selected "windshield" as a part you would like installed, is there a shaded band (a darker area of color, not black) across the top?  yes no

Location of Installation:

Home Work Sunshine Auto Glass 
Other (enter address)

Would you prefer a confirmation by:

Phone Call - daytime number
E-Mail - preferred address

How did you find out about Sunshine Auto Glass on the internet? 
(you can choose as many as apply by holding the Ctrl key while selecting 
with the left mouse button)
Search Engine (infoseek, yahoo, etc.) My Insurance Agency My Insurance Company A friend told me about it A mechanic/dealership/other business Yellow Pages On-line Yellow Pages e-Mail from Sunshine Auto Glass Marketing Other

Thank you for choosing Sunshine Auto Glass for your automotive 
glass replacement. You should have a response in less than 24 hours.