Schedule Service About Your Vehicle *Year: Select a Year 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 < 1970 *Make (ie; Ford, Saab, Toyota, etc.): Select Make ACURA AIRBUS ALFA ROMEO AMERICAN MOTORS AUDI AUSTIN AUTOCAR AVANTI BERING BLUEBIRD BMW BOUNDER BOYERTOWN BRICKLIN BROCKWAY BUICK CADILLAC CHECKER CHEVROLET CHRYSLER COLUMBUS CORDURA DAEWOO DAIHATSU DATSUN DELOREAN DIAMOND REO DODGE EAGLE EDSEL FIAT FLYER BUS FORD FREIGHTLINER FWD GEO GMC GMC TRUCK GRUMMAN OLSON HINO HOLIDAY RAMBLER HONDA HUMMER HYUNDAI INFINITI INTERNATIONAL ISUZU IVECO JAGUAR JEEP KENWORTH KIA LANCIA LAND ROVER LEXUS LINCOLN MACK MAGIRUS MASERATI MAZDA MCI MERCEDES BENZ MERCURY MERKUR MG MINI MITSUBISHI NATIONAL COACH NAVISTAR NISSAN OLDSMOBILE OPEL PACE ARROW PETERBILT PEUGEOT PLYMOUTH PONTIAC PORSCHE PREVOST BUS RENAULT ROLLS ROYCE ROVER SAAB SATURN SCANIA SCION SEAT SILVER EAGLE SIMCA SOUTHWIND STERLING STERLING TRUCKS STUDEBAKER SUBARU SUNBEAM SUZUKI TOYOTA TRIUMPH UTILIMASTER VOLKSWAGEN VOLVO WESTERN STAR WHITE YUGO *Model (ie; Escort, 900S, Celica, etc.): *Part Required (You may choose as many parts as needed) 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 Options 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) Convertible 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 Method of Payment Bernard AutoGlass will directly bill your insurance company or agency. Leave the hassel 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 (N/A) Insurance Company Insurance Agency I don't have glass coverage, bill me at time of installation Note: If you are not certain if you have coverage, select "Bill my insurance agency" and provide your agent's name. We will call to verify coverage. Your Information *Your Name: Your Home Address: Your City: *Your State: *Your Zip Code: *Your e-mail Address: *Home Phone: *Work Phone: *Preferred Date of Installation: Location of Installation: Home At my Workplace Other (enter address) Would you prefer a confirmation by: Home Phone Work Phone E-Mail How did you find out about Bernard AutoGlass 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 Bernard AutoGlass Other Comments? *=Required Thank you for choosing Bernard AutoGlass for your service. You should have a response in less than 24 hours.
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
Bill my insurance company/agency (N/A)
Thank you for choosing Bernard AutoGlass for your service. You should have a response in less than 24 hours.