Company Info
Reglazing
Cabinets
Counter Tops
More Info
Contact

ORDER FORM

Order Form

Contact

Request an Estimate

 

Contractor License #825456

 

 

 

 

Use this online order form as a convenient way to expedite the processing of your order.   You can also print this off and fax it to
818 541-0403.

We will contact you to finalize and schedule the job including providing you with an accurate telephone estimate of the price for the job.  

Or call (800)55-PACIFIC or (818) 541-0404 if you prefer to place your order by phone.            
                                                      * = information required

Customer Name: (Owner or Company name)
Person Requesting:  Title:
  Are you a new customer?  Yes   No
Phone No: * (your phone - to confirm & finalize order)
Your email:  
Job Site Name: (eg. Name of Apt bldg)
Job Site Address: *
Job Site City:  * Zip: *
Unit Number(s):   If job is in an apartment, which unit(s)
Vacant? * (is this a vacant unit or house? - yes or no)
Site Contact:    Site Phone:
Tenant Name:
(if applic.)
Tenant Ph: 
Description of work to be done: *
Color: (White, Almond or Custom)
Special Instructions:
 
(Note: No one should be in the unit for approximately 4 hours after the job is done to allow time for fumes to clear).

We will contact you to finalize and schedule your order. 


 

 

 

 

 

Home | About Us | Reglazing | Cabinets | Counters | Contact | More Info

Copyright 2005-2010 Pacific Reglazing, Inc. All Rights Reserved