Create a booking.

Please fill out the short form and include all the details required for us to correctly identify your vehicle glass. Have your insurance documents and vehicle log book to hand.

Remember, Island windscreens Prestige members get 1x Free Internal/External Rapid valet per month as part of their plan! Learn more Here

Prefix

First Name

Middle Name

Last Name

Phone *

Email Address *

Street Address *

Town/City

Parish

Post Code

Policy Number *Please provide us with your policy number

Who are you insured with? *Please note, we require the insurer, in most cases this will be on your certificate of motor insurance

Insurance ReferalYesNoWere you refered to us by your insurer

Vehicle Make and Model *Please confirm the Make and Model of your vehicle

Vehicle Registration *Please provide your Vehicle registation number0 / 8

Chassis/VIN Number *Please provide us with your chassis/VIN number. It is located on the bottom right hand corner of your windscreen or on the B-Pillar of your vehicle0 / 17

Upload file *

Drag and Drop (or) Choose Files

Please upload an image of screen or vehicle glass to help us better identify the correct glass for your vehicle

Service requirements *Please select which service you require

Consent for information sharing *I agreeI DisagreeI agree for Island Windscreens to use the information provided to pass on to Autoglass and other Autoglazing businesses, should it be required.

Any other relevant informationIf there is anything else we have missed, or should know. Please write in the box

36 Spring Valley Industrial Estate

Spring Valley

IM2 2QS

tel: 07624320038

E-mail: Support@hireme.im

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