GO Headlight Restoration–Windshield Repair Inquiry

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

*PLEASE READ FIRST

If you have a damaged windshield, immediately cover the impact point with a thick piece of clear tape to prevent dust and water from entering the damaged area. Water expands and contracts as temperature changes. Which will further your damaged area if it entered into the glass. Moisture and dirt inside the impact point will also result in a less than desirable repaired finish.

CONTACT INFORMATION

First *

Last *

Email Address *

Phone Number *

Preferably a mobile phone with texting and voicemail features

WINDSHIELD DAMAGE DETAILS

Location of Damage *

Please identify the location of damage and the number of damages in each region.

Type of Damages *

Please identify the type of break your windshield has

Bulls-Eyes

Star Break

Combination Break

Floating Cracks

Edge Cracks

Required

Size of Damage *

Up to the Size of a Quarter

Break Under 2 Inch

Crack Under 6 Inch

Crack Over 6 Inch

Required

Does the damage reach to the edge of windshield? *

Yes

Did the damage pass through the inner glass? *

Yes

Not Sure

Have the vehicle been in prior collision? *

Yes

VEHICLE DESCRIPTION

Make *

Model *

Year *

Color *

Zip-Code of Vehicle Location *

VEHICLE LOCATION

Vehicle Parked *

At Owner's Address (Garage or Driveway)

Random Street Parking

Parking Garage

GENERAL

Questions or Comments

Preferred method of contact *

Text Message

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms