| Type of Inquiry: |
|
| First Name: |
|
| Last Name: |
|
| Address Street 1: |
|
| Address Street 2: |
|
| City: |
|
| Zip Code: |
(5 digits) |
| State: |
|
| Daytime Phone: |
|
| Evening Phone: |
|
| Best Time to Call: |
|
| Email: |
|
| Type of Watch: |
|
| Case/Band Color: |
|
| Manufacture (brand): |
|
| Model # (on case back): |
|
| Serial # (on case back): |
|
| Stones: |
|
| Stone Color: |
|
Water Resistance Level (on case back): |
|
| Have you or a jeweler opened the watch for repair? |
|
| When was the watch last serviced? |
|
| Where was the watch purchased? |
|
| How old is the watch? |
|
| Is the watch working/keeping time? |
|
| Is the watch intact, or in several parts? |
|
| Describe the problem: |
|
Type of Repair/Service you are inquiring about? |
|
| Inquiring about more than one SERVICE, please specify in this area using the information in the drop-down box above. |
|
| Type of Part(s) you are inquiring about? |
|
| Inquiring about more than one PART, please specify in this area using the information in the drop-down box above. |
|
|
|