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Your Name is a required field.
Company Name is a required field.
The first Address is a required field.
City is a required field.
State is a required field.
Zip is a required field.
Please enter a flat cost estimate for labor-only installations.
Please enter at least an estimated percentage discount for Foreign & Domestic glass.
Please enter at least an estimated percentage discount for Tempered glass.
Please enter your primary glass supplier / distributor.
* denotes a required field.
  Contact Information
Name  *
Title
Phone    Ext.
Email Address
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  Company Information
Company Name  *
Address1  *
Address2
City  *
State  *
Zip  *
Phone 1:    *
Phone 2:   
Fax:   
Website: (Example: www.yourshop.com)

Our company does not have a website.
Federal Tax ID#
# of Technicians Per Location (average per location)  
    Note: You will be prompted to fill out information about each of your locations.
 Mobile Service
Do you provide mobile service?   Yes
Furthest distance willing to mobile for replacement job:
  miles

 Business Days/Hours of Operation
 Mon
Hours:  		 Tue
Hours:  		 Wed
Hours:  		 Thu
Hours:  		 Fri
Hours:  		 Sat
Hours:  		 Sun
Hours: 

 Supplier / Distributor Location
Who is your primary glass supplier / distributor?
  *
How far away is your primary glass supplier / distributor (i.e. 25 miles)?

 Glass and Installation Pricing
Please keep the following information in mind when preparing your bid: We are, in essence, a national fleet account — our fleet of vehicles is comprised of a wide variety of corporate, government, small business and privately owned vehicles. Our marketing efforts allow many retail customers to purchase through our national fleet account as well. Our goal is to establish a long-term relationship with ONE preferred supplier in each market we serve. The pricing you submit should be competitive with cash/fleet/dealer pricing in your area in order to secure our account.

Please provide an estimate for BOTH of the following pricing scenarios.
(Keep in mind that this pricing you provide is simply a survey and is not binding on your shop in any way.)

Scenario 1 — Labor Only Pricing
We provide the glass (glass, moldings, clips, etc.) & you supply the installation labor including mobile service.
Bid on windshield installation (flat cost, installation labor only):
 $ *

Scenario 2 — Glass & Labor Pricing
We buy the entire job from you — including glass (glass, moldings, etc) & installation, labor, materials & mobile service.

This pricing should be expressed as a flat percentage discount off NAGS list prices and will cover everything needed to complete the installation including materials and moldings (except special order/dealer parts).
Foreign & Domestic Windshields
  % Off NAGS List *
Tempered Glass
  % Off NAGS List *
 
 
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