Brisbane Glass - That's The One!

Our priority email ordering system is at your service during the business hours of Monday to Friday 7.30am to 5.00pm. (public holidays excluded) for outside these times our After Hours Priority Mobile Service is available on (07) 3376 5575

Please complete our job order form and then submit this via the submit button at the page bottom. Our customer service representative will be in contact with you promptly.

(* indicates fields that must be completed)

Your personal information is collected, used and disclosed by Brisbane Glass in accordance with its Privacy Policy ( At the bottom of this page )

Order Form
Customer Details
Business Name:
* Salutation:
* First Name:
* Last Name:
Position:
Address:
Suburb:
Post Code:
* Phone Number:
Mobile Number:
E-mail:
Job Details
Site contact first name:
Site contact last name:
* Date you would like it fixed:	dd mm yy
* Preferred Time:
* Phone:
Mobile:
* Address:
* Suburb:
* Postcode:
* Description of work to be done:
Insurance Details
Cause of Damage:
Insurance Company:
Insurance Company Address
Claim Number
Insured's Full Name
Insured's Home Address
Policy Number:
Expiry Date:	dd mm yy
Excess Amount:
How Did Breakag Occur
Date & Time of Breakage	dd mm yy time
Product Details
Usage:
Quantity:
Height:
Width:
Additional Comments:

Privacy Policy
It is important to us that you are confident that any of your Personal Information entrusted to us is treated with the appropriate degree of privacy.
Personal information, is any information about you or your client by which the identity of, can be reasonably determined.
Collecting your Personal Information is essential for Brisbane Glass to be able to conduct its business in the areas of Work Order Acceptance and Insurance Claim Lodgement. To enable us to do this we may share your Personal Information with the related Insurance Companies, Insurance Brokers, insurance reference agencies, assessors, or investigative service providers, that you have nominated for us on our email / fax forms.
It is very important that the Personal Information we collect from you is accurate, complete and up-to-date.
The protection of your Personal Information is a priority for Brisbane Glass. This is why we take all reasonable precautions to safeguard your personal information from loss, misuse, unauthorised access, modification or disclosure. Brisbane Glass does not send Personal Information to any other parties other than those as mentioned above and constantly reviews all its policies and procedures to keep up to date with the changes in the law.