Pollack Glass Company: Make an Appointment!


	MAKE AN APPOINTMENT

To Schedule service or request a quote for auto glass repair, just fill out the form below and click submit. A Pollack Glass Representative will contact you during standard business hours regarding your internet inquiry. Please use the "comments" section below to specify at which telephone number you prefer to be contacted or if you prefer an e-mail response. For immediate attention, you may contact Pollack Glass at (800) 292-0714 .

*All fields marked with an asterisk are optional

Vehicle Information

Year of Vehicle:

Make of vehicle:

Model: (Escort, Prelude, etc.)

Body Style:

VIN*:

Damaged Part:

Part Color:

Your Information

First Name*:

Last Name:

Street Address:*

City:

State:

Zip:

Home Phone:

Work Phone:

Other (beeper, fax, etc.)*

E-mail:

Other Information

Insurance Co:*

*Date of incident
(mm/dd/yy):

Policy No.:*

Cause of damage*:

Deductible:*

Service:

Quote Request Only Mobile
Drive-in

Comments*:

Any information submitted to Pollack Glass will be used for the sole purpose of servicing your vehicle.

Send questions and comments to webmaster@pollackglass.com
�1999 Pollack Glass Company

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Pollack Glass Company
930 East Michigan Avenue
Lansing, MI 48912

(517) 482-1821
(800) 292-0714
e-mail: info@pollackglass.com