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Auto Glass: Online Quote Form & Appointment Scheduler

Ray Sands Glass is a regional glass retailer serving the greater metropolitan Rochester, NY and Canandaigua, NY areas. (Up to 50 mi. radius) We cannot provide pricing for auto glass replacement outside our service areas.

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Required Fields *

	Personal Information:
	First Name*:
	Last Name*:
	Street Address*:
	City*:
	State:
	Zip Code*:
	Email Address*:
	Phone*:

	Vehicle Information:
	Vehicle Year:
	Make:
	Model:
		SUV Pick up Truck
		2 door 4 door
	Which window is damaged:
	If front windshield is selected, please check all that apply:
		Shaded Windshield
		Rain Sensor
		Heads Up Display
		Heated Windshield

	Method of Payment:

	If you would like to go ahead and setup an appointment, please fill in the additional information below.
	How did you hear about us?:
	Add me to your monthly email specials
	Special Instructions: Please use this area to provide us with your insurance company name, agent and policy number if your are scheduling an appointment and submitting an insurance claim.