Rickerts Auto Glass Michigan / Windshield Replacement Services

		Please fill out and submit the following form for a FREE PRICE QUOTE!


Year	Make (i.e.; Ford, Saab, Toyota, etc.)	Model (i.e.; Escort, 900s, Celica, etc.)

		Number of Doors:

Glass Tinting
What color tinting is the glass in your vehicle? (You can check by holding a whitepaper up behind an open door window). NOTE: Nearly ALL vehicles have tinted glass today - clear glass is usually MORE expensive.

		Glass Shading 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?

		First Name *		Last Name *

		Street Address

		City		State		Zip Code

		E-mail Address *

		Contact Phone		How do you wish to be contacted?

		How did you hear about us?

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