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Step 1 (Fill)Step 2 (Preview)Step 3 (Finish) WARRANTY REFERENCE # 1202-2223-5308-09 CUSTOMER INFORMATION Name: Address: City: State or Province: Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Select Zip: Phone: 1- - - Email: APPLICATOR DETAILS Company Name: Applicator #: use 0000 City: State or Province: Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Select Zip: ADDITIONAL COMMENTS FILM INSTALLATION INFORMATION Installation Date: Glass Type (Check): Single Pane Double Pane Film Type (s): Total Square Footage Installed: # of Double Pane Windows: Previous glass breakage or seal failure? Yes No Is the largest single window pane treated "equal to" or "greater than" 20 square feet? Yes No ADDITIONAL GLASS INSURANCE I do not have a window greater than 20 sq. ft, yet I would like additional insurance: Yes No *Additional insurance is calculated at .50$ per square ft. All windows must be covered. Minimum charge for insurance is $75. You will be contacted upon submission of this registration to finalize glass insurance.
CUSTOMER INFORMATION
Zip:
Email:
APPLICATOR DETAILS
ADDITIONAL COMMENTS
FILM INSTALLATION INFORMATION
Glass Type (Check):
Single Pane Double Pane
Film Type (s):
Total Square Footage Installed:
ADDITIONAL GLASS INSURANCE I do not have a window greater than 20 sq. ft, yet I would like additional insurance: Yes No
