Book a Job

Please fill in the information below to book a job online.
An Express Glass representative will call you to confirm availability.
You will be contacted between 7.00 am – 6.00 pm on MONDAY to FRIDAY ONLY.

If it is an EMERGENCY, please call us now on 1300 666 234

*denotes a required field.

Customer Details
Title	Please select Mr Mrs Ms Miss Dr
First Name*
Surname*
Company Name
Street Address*
Suburb*
State*
Postcode*
Phone Number*
Email Address*

 

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Job Details same as customer details
Title	Please select Mr Mrs Ms Miss Dr
First Name
Surname
Company Name
Street Address
Suburb
State
Postcode
Phone Number
Email Address

 

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Appointment Details
Preferred Date	Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December
Preferred Time	8am - 12pm 12pm - 4pm
Other Info

 

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Services Required
Repair Broken Window
Repair Broken Door
Repair Shop Front
Other

 

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Have you used Express Glass before?	Yes No
Would you like us to bill your Insurance Company?	Yes No
Insurance Company
Policy Number
Excess Amount

 

 

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