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 UPDATED 03-09-2010

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AUTO GLASS QUOTE AND REPLACEMENT FORM

Name:

City:

First

State:

Last

Zip Code:

Phone Number:

Email Address:

Confirm Email Address:

Vehicle Information:

Year:

Make:

Model:

VIN:

Glass Needing To Be Replaced:

Please note all glass options. Example: tint code, band on top of windsheild, ect.

[HOME] [REBUILDERS I] [REBUILDERS II] [ABOUT US]

Hours of Operation - Monday-Friday - 7:30-5:00     Saturday - 7:30-12:00

Lems Auto Recyclers ~ 402 Gere Ave.~Doon, IA~51235     1-800-257-9634 or 712-726-3202

www.lemsauto.com                                                         E-mail - search@lemsauto.com

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