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info@binswangerglass.com             1.800.365.9922


Schedule Service

Vehicle Information

* Year:
* Make (i.e Ford Saab, Toyota, etc.):
* Model (i.e Escort, 900S, Celica, etc.):

* Part (You may choose as many as needed)

Windshield

Driver's Front Door

Driver Front Door Vent

Driver Side Rear Door

Driver Side Rear Door Vent

Driver Side Quarter

Backglass

Windshield Repair

Passenger's Front Door

Passenger's Front Door Vent

Passenger's Side Rear Door

Passenger's Side Rear Door Vent

Passenger's Side Quarter

Other   

Options

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

Antenna in windshield

Heads Up Display

Heated Windshield

Sunroof

Overhead Console

Convertible

Rear Defroster

Vinyl Roof

Sliding/Moveable

Rear Wiper

Antenna in Backglass

Other Options

Privacy Glass

Hatchback

Sedan

Extended Cab (truck)

Crew Cab

* Number of Doors

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)

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?

Method of Payment

Binswanger Glass will directly bill your insurance company or agency. Leave the hassle of collecting to us - that's what we are trained to do. For deductibles or payment in full, you may use cash, check or credit card.

Bill my insurance company/agency

Insurance Company

Insurance Agency

I don't have glass coverage bill me at the time of installation

Your Name:

Your Home Address:

Your City:

Your State:

Your Zip Code:

Your Email Address:

Personal Phone:

Work Phone:

Location of Installation

Home

The Binswagner store nearest me

Other (enter address)

Would you prefer a confirmation by:

Personal Phone

Work Phone

Email

How did you find out about Binswanger Glass on the internet? (you can choose as many as apply by holding the ctrl key while selecting with the left mouse button)

Comments:

*= Required

Thank you for choosing Binswanger Glass for your service. You should have a response in less than 24 hours.

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  1.800.365.9922