Name:    Email Address:

Address: City:   State:   Zip:  

Phone: Daytime Evening:

Home Information

Lot #:    Subdivision:

Builder:   Closing Date:

Are you the original homeowner?...(check one)
Yes
No

Are there any after-market "sun blocking" films applied to the windows?...(check one)
Yes
No

My window problem is...(check one)
Fogged up between the glass panes? - or -
Moisture on the surface where it can be wiped off? (Condensation) - or -
Glass is Scratched, Cracked or Broken

Is the interior of the product 
Vinyl?   Wood?    Steel? (door only)

Is the exterior of the product
Vinyl?  Aluminum-clad wood?  Painted wood?  Steel? (door only)

Is the product color 
White?   Tan?  Gray?  Brown?  Green?

The glass is in the following product:

Double Hung - Bottom sash slides up and top sash slides down
A: Top Sash   B: Bottom Sash
Single Hung - Bottom sash slides up and top sash is stationary
C: Top Sash   D: Bottom Sash
E: Slider - One sash slides to the side and the opposite sash is stationary
F: Casement - Operating sash is hinged at the side and cranks open (Not all casement sashes open.  Fixed casements are sometimes attached to operating casements.)
G: Awning - Sash is hinged at the top and cranks open
H: Sliding Patio Door - One door slides to the side and the opposite door is stationary
I: Swing Patio Door - One door is hinged and the other is stationary
J: Fixed Window - No sashes open
K: Non-Rectangular Shape - Oval, Half-Round, Octagon etc.

Glass Daylight Area:  Width       Height

Are there grids between the glass? No Yes If yes, what is the grid pattern?

Number of horizontal bars    Number of vertical bars

(For NORCO windows Only) Code stamped on the silver spacer between the glass.
Note: If you do not see this code, leave question blank.
Code is:

The product is located in what room? (Note if over tub or directly beside a door)

Additional Comments:

Second Glass Panel

Second glass panel:
A: B: C: D: E: F: G: H: I: J: K:

Glass Daylight Area:  Width       Height

Are there grids between the glass? No Yes If yes, what is the grid pattern?

Number of horizontal bars    Number of vertical bars

(For NORCO windows Only) Code stamped on the silver spacer between the glass.
Note: If you do not see this code, leave question blank.
Code is:

The product is located in what room? (Note if over tub or directly beside a door)

Additional Comments:

Third glass panel:
A: B: C: D: E: F: G: H: I: J: K:

Glass Daylight Area:  Width       Height

Are there grids between the glass? No Yes If yes, what is the grid pattern?

Number of horizontal bars    Number of vertical bars

(For NORCO windows Only) Code stamped on the silver spacer between the glass.
Note: If you do not see this code, leave question blank.
Code is:

The product is located in what room? (Note if over tub or directly beside a door)

Additional Comments:

I would like service as follows: (check one)
I will pick up replacement glass at Atria and install it myself (No charge on warranted glass).
I will bring in my sash for Atria to replace the glass in their shop (No charge on warranted glass).
My glass is under warranty and it has been less than 2 years since the date of purchase.
Order and install the glass according to the 2 year free service warranty.
My glass is under warranty, but it has been more than 2 years since the date of purchase.
I understand that there is a service call charge plus possible installation charges.
My glass is out of warranty or broken, I want to order replacement glass and have it installed.  Service charges will apply.
I have NORCO brand windows. Order the glass installed in a new sash. I will pick it up at Atria.
(No charge on warranted glass, but requires finishing).

I have read all service call options and fully understand that I am responsible for any labor and / or material costs that may apply to my order. By submitting this form I agree to pay, upon completion of work, all applicable charges incurred. Atria ultimately reserves the right to determine what is or is not considered chargable.