Autoscreenz Chip Repair or Crack Repair Estimate /Booking Form

Chip or Crack Repair Bookings. We work by appointment only.Please note: For your safety and ours, No telephonic bookings will be accepted
Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Physical Address where repair will be done. We do not meet clients at Garages, Street corners etc. We will come to your work address or home address. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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What type of chip do you have? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Please identify the type of damage.

Size of chip {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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What is the size of the damage?

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Autoscreenz Chip Repair or Crack Repair Estimate /Booking Form

Autoscreenz Chip Repair or Crack Repair Estimate /Booking Form

Chip or Crack Repair Bookings. We work by appointment only.Please note: For your safety and ours, No telephonic bookings will be accepted
Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Physical Address where repair will be done. We do not meet clients at Garages, Street corners etc. We will come to your work address or home address. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Company Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Comments or Questions {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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What type of chip do you have? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Size of chip {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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I have read the terms and conditions available at www.autoscreenz.co.za. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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I am aware of the fact that broken glass is unpredicatble and fragile. Although an Autoscreenz technician will take the utmost care in repairing your windscreen, I agree that in the event that a chip cracks out Autoscreenz will not be held liable to replace the windscreen. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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I am aware that although Autoscreenz™ uses Diamond Resin™ for the repair, any dirt already in the chip cannot be removed by Autoscreenz™ and will remain in the glass. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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I would like to be quoted on a replacement glass for my vehicle. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Vehicle make and model {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Please note: Although we will communicate an approximate time to repair, we cannot guarantee the arrival time due to unpredicatble repair times / customer delays / traffic. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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