Pacific Reglazing, Inc. - Online Estimate Form

Use this online order form as a convenient way to expedite the processing of your order or to request an estimate. You can also print our fax order form and fax it to 818 541-0403.

If you simply want to ask a question, use our inquiry form.

We will contact you to answer any remaining questions, give you a telephone estimate, then if you are ready to go we will schedule the job.

Call (800) 557-2243 or (818) 541-0404 if you have any questions or wish to place your order by phone.

* = required fields

CUSTOMER NAME
Customer Name: *	(Owner or Company name)
Person Requesting: *		Title:	(eg. owner, manager)
CONTACT INFORMATION
New Customer?	Yes (check here if this would be your first order from us)
Phone No: *	(your phone - to confirm & finalize order)
Your email: *
JOB SITE INFORMATION
Job Site Name:	(eg. Name of Apt bldg)
Job Site Address: *
Job Site City: *		Zip: *
Unit Number(s):	If job is in an apartment, which unit(s)
Vacant Unit? *	Yes (check here if no one is currently living in the unit or house)
Site Contact:	(if any)	Site Phone:
Tenant Name:	(if any)	Tenant Phone:
WORK DESCRIPTION
Description of work you need: *
Color:	(White, Almond or Custom)
Other Instructions / or questions:
(Note: No one should be in the unit for approximately 4 hours after the job is done to allow time for fumes to clear). Terms and Conditions: Please indicate below that you AGREE to our standard terms of service, or that you will be onsite to provide a signature on the order before commencement of work. Note that price is not specified in this agreement at this time as price will be finalized prior to start of work. This agreement may be withdrawn at any time prior to commencement of work. I agree to your standard terms of service, or I will be onsite to review terms and provide my signature.