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Job Request

This form is intended for use by NEW ZEALAND AUTO GLASS account holders only. [*] Denotes a required field.

// JOB DETAILS

// COMPANY DETAILS

Select 'Other' if your Branch is not listed

// VEHICLE DETAILS

Select 'Other' if your Make is not listed
Select 'Other' if your Year is not listed
Select 'Other' if your Body Style is not listed
Select 'Other' if your Work Required is not listed

// FRONT WINDSCREEN FEATURE(S)

Check all that apply above

// REAR WINDSCREEN FEATURE(S)

Check all that apply above

// SIDE / DOOR GLASS PART(S)

Check all that apply above

// IMAGE(S) UPLOAD

Maximum filesize of 4 MB per image

// COMMENTS / INFORMATION

Did You Know?

Your windscreen plays an important role in the structural integrity of your vehicle. In the event of a rollover, the windscreen is designed to help keep the roof from collapsing while keeping the passengers inside the vehicle, which greatly increases their chances of survival.

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