083 370 0045

michelle@perfectglass.com.na

Unit 17, Hyper Motor City, Maxwell Street, Windhoek, Namibia

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083 370 0045 / 0046 / 0047

michelle@perfectglass.com.na

Unit 17, Hyper Motor City,
Maxwell Street, Windhoek, Namibia

Windscreen Replacement Quotation Form

Please enable JavaScript in your browser to complete this form.

Name *

First

Last

Contact Number *

Email *

Address *

an claim, your

Vehicle Make *

Vehicle Model *

Vehicle Registration Year *

Vehicle Identification Number *

Does your Vehicle have a: (tick if yes) *

Rain Sensor
Heat Shield
Antenna

Additional Info (tick if applicable) *

There is a windscreen wiper on the glass
Vehicle is imported
Vehicle is imported from another country, and is a left-hand drive vehicle
There is a brake light mounted on the glass
The replacement of the windscreen is an Insurance claim

If an Insurance claim, please provide Insurance company info

083 370 0045 / 0046 / 0047

michelle@perfectglass.com.na

Unit 17, Hyper Motor City,
Maxwell Street, Windhoek, Namibia

Windscreen Replacement Quotation Form

Please enable JavaScript in your browser to complete this form.

Name *

First

Last

Contact Number *

Email *

Address *

Vehicle Make *

(tick if please

Vehicle Model *

Vehicle Registration Year *

Vehicle Identification Number* *

Does your Vehicle have a: (tick if yes) *

Rain Sensor
Heat Shield
Antenna

Additional Info (tick if applicable) *

There is a windscreen wiper on the glass
Vehicle is imported
Vehicle is imported from another country, and is a left-hand drive vehicle
There is a brake light mounted on the glass
The replacement of the windscreen is an Insurance claim

If an Insurance claim, please provide Insurance company info

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Unit 17, Hyper Motor City,
Maxwell Street, Windhoek,
Namibia

083 370 0045

michelle@perfectglass.com.na