Request Glass Replacement — Medixa Fleet Solutions

Step 01 / 06

Contact details

Who should our team contact about this request?

Contact name

Company / fleet name Optional

Phone

Preferred contact method Optional

Phone call Email Text message

Step 02 / 06

Vehicle details

Tell us what you know — year, make and model help us confirm the correct glass.

Vehicle category

Vehicle / unit / fleet number Optional

Year If known

Make If known

Model If known

VIN Optional

Why we ask: the VIN helps identify the exact glass part and features for your vehicle. You'll find it on the driver-side dash or door-jamb sticker.

PO / reference Optional

Step 03 / 06

Glass details

Which glass needs to be replaced? Select all that apply.

Glass to replace

WindshieldFront windshield, one- or two-piece Driver-side door glassLeft front door window Passenger-side door glassRight front door window Other side / rear door glassRear doors, sliding door, sleeper Rear / back glassBack window or rear door glass Quarter glassSmall fixed side windows Other / not sureDescribe it below

Position / side and additional notes Optional

What happened / what is needed

0/2000

Step 04 / 06

Vehicle location

Where is the vehicle located? This helps our team confirm availability for your request.

Vehicle location — street address or yard

City

State

ZIP

Requested date Optional

Location / access notes Optional

A requested date is a preference only — our team will contact you to confirm next steps and availability.

Step 05 / 06

Photos

Optional, but helpful: the damaged glass, the whole vehicle side, and the VIN or door sticker.

Drag & drop photos here

or browse your device · JPG, PNG or WebP · up to 8 photos, 10 MB each, 40 MB total

Step 06 / 06

Review & submit

Check your details. Submitting sends a request — it is not a confirmed appointment.

Request received

Thank you — your glass replacement request has been received. This is not yet a confirmed appointment: a Medixa representative will review it and contact you to confirm next steps and availability.

REQUEST REFERENCE—

01Our team reviews your vehicle details and photos.
02A representative contacts you to confirm the correct glass, next steps and availability.

Back to home