5 Year Windshield Registration

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Installer Information

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Installer Name*
Installer Billing Address*
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Customer Information

Customer's Name*
Make sure this is as accurate as possible, so we can email the customer their warranty.
Customer's Address*

Warranty Type

Choose between Standard and Luxury. Luxury: Acura, Audi, BMW, Cadillac, Hummer, Infiniti, Jaguar, Land Rover, Lexus, Mercedes, Porsche, Saab, VW, and any vehicle with an original MSRP in excess of $150,000.00 | Standard: All other makes

Vehicle Information