Front Windscreen Type :
Standard front windscreen
Front windscreen with rain sensor
Front windscreen acoustic
Front windscreen acoustic with rain sensor
Front windscreen heated
Front windscreen heated with rain sensor
Front windscreen heated and acoustic with rain sensor
Registration Number:
Name:
Phone
Email:
Job Address to Replace Glass :
Preferred Day:
Monday
Tuesday
Wednesday
Thursday
Friday
Urgent Service
Preferred Time Slot:
Morning 8:00am - 12:00pm
Mid Day 10:00am - 2:00pm
Afternoon 12:00pm - 4:00pm
Anytime. We will contact you before arriving.
Insurance Broker if known
Policy number if you have
Insurance Status:
I have full insurance
I have glass cover
Not Insured
Additional Information:
Lumley Windscreen Claim
Side and Back Glass Claim
Side or Back Glass to replace:
Front Door Driver side window
Front Door Passenger side window
Rear Door Driver side window (Wind down glass)
Rear Door Passenger side window (Wind down glass)
Rear Door Driver side quarter glass (Small fixed glass)
Rear Door Passenger side quarter glass (Small fixed glass)
Rear Side panel glass, Driver side
Rear Side panel glass, Passenger side
Back Glass / Rear Hatch / Back Window
Glass Color:
Light or clear tint colour
Darker privacy tint
Registration Number
Name
Phone
Email
Job Address to Replace Glass
Preferred Day
Monday
Tuesday
Wednesday
Thursday
Friday
Urgent Service
Preferred Time Slot
Morning 8:00am - 12:00pm
Mid Day 10:00am - 2:00pm
Afternoon 12:00pm - 4:00pm
Anytime. We will contact you before arriving.
Insurance Broker if known.
Policy number if you have
Insurance Status:
I have full insurance
I have glass cover
Not Insured
Additional Information:
Either fill in the form below or
Call 0800 563-563
for glass and windscreen bookings
Insured with Lumley - Get your windscreen or glass fixed now
Got a Lumley Windscreen Claim. Call 0800 563-563 to get your windscreen replaced promptly with our free mobile service.
For a quality windscreen equal or better than what you already have contact
Machglass
All work guaranteed for the life you own the vehicle.
Guarantee not to put an XYG branded windscreen in your vehicle.
Lumley Windscreen Claim
Front Windscreen Type :
Standard front windscreen
Front windscreen with rain sensor
Front windscreen acoustic
Front windscreen acoustic with rain sensor
Front windscreen heated
Front windscreen heated with rain sensor
Front windscreen heated and acoustic with rain sensor
Registration Number:
Name:
Phone
Email:
Job Address to Replace Glass :
Preferred Day:
Monday
Tuesday
Wednesday
Thursday
Friday
Urgent Service
Preferred Time Slot:
Morning 8:00am - 12:00pm
Mid Day 10:00am - 2:00pm
Afternoon 12:00pm - 4:00pm
Anytime. We will contact you before arriving.
Insurance Broker if known
Policy number if you have
Insurance Status:
I have full insurance
I have glass cover
Not Insured
Additional Information:
Lumley Windscreen Claim
Side and Back Glass Claim
Side or Back Glass to replace:
Front Door Driver side window
Front Door Passenger side window
Rear Door Driver side window (Wind down glass)
Rear Door Passenger side window (Wind down glass)
Rear Door Driver side quarter glass (Small fixed glass)
Rear Door Passenger side quarter glass (Small fixed glass)
Rear Side panel glass, Driver side
Rear Side panel glass, Passenger side
Back Glass / Rear Hatch / Back Window
Glass Color:
Light or clear tint colour
Darker privacy tint
Registration Number
Name
Phone
Email
Job Address to Replace Glass
Preferred Day
Monday
Tuesday
Wednesday
Thursday
Friday
Urgent Service
Preferred Time Slot
Morning 8:00am - 12:00pm
Mid Day 10:00am - 2:00pm
Afternoon 12:00pm - 4:00pm
Anytime. We will contact you before arriving.
Insurance Broker if known.
Policy number if you have
Insurance Status:
I have full insurance
I have glass cover
Not Insured
Additional Information:
Either fill in the form below or
Call 0800 563-563
for glass and windscreen bookings
Insured with Lumley - Get your windscreen or glass fixed now
Got a Lumley Windscreen Claim. Call 0800 563-563 to get your windscreen replaced promptly with our free mobile service.
For a quality windscreen equal or better than what you already have contact
Machglass
All work guaranteed for the life you own the vehicle.
Guarantee not to put an XYG branded windscreen in your vehicle.
Lumley Windscreen Claim