Security Code: *
First Name: *
Last Name: *
Daytime Phone: *
Email - You MUST provide!: *
Type of Watch:	Select from drop-down list below Lady's Quartz Lady's Mechanical Men's Quartz Men's Mechanical Pocket Watch Unsure
Case/Band Color:	Select from drop-down list below White (Stainless) Yellow (gold-tone) Two-tone (stainless & gold-tone) Titanium Plastic
Manufacture (brand): *
Model # (on case back):
Serial # (on case back):
Do you bathe or swin w/ watch?:	Yes No
Water Resistance Level (on case back):	Nothing on Case Back Water Resistant Water Resistant 50m Water Resistant 100m Water Resistant 150m Water Resistant 200m Water Resistant 300m (or higher)
Have you or a jeweler opened the watch for repair?	Yes No
When was the watch last serviced?	Don't know Less than 1 year ago 2-3 years ago 3-5 years ago 5-10 years ago More than 10 years ago
Who serviced the watch?
Where was the watch purchased?	Select from drop-down list below A gift A store (authorized to sell watch) Ebay Purchased second hand/used Found at relative's home Unsure
How old is the watch?	Less than one (1) year Two (2) to Three (3) Years Three (3) to Five (5) Years Five (5) to Seven (7) Years Seven (7) to Ten (10) Years Ten (10) to Fifteen (15) Years Fifteen (15) to Twenty (20) Years Twenty (20) to Thirty (30) Years 1940's to 1950's 1920's to 1940's Early 1900's Late 1800's Older than Father Time Impossible to Guess
Is the watch working/keeping time?	Yes No
Is the watch intact, or in several parts?	Intact - no sign of damage Intact - with signs of damage Not intact - watch in pieces
Describe the problem: *	Enter description of problem (here).
Type of Part(s) you are inquiring about?	Select from drop-down list below Bracelet/Band Link Bracelet/Band Clasp/Buckle Bracelet/Band Replacement New Bezel New Dial New Hands New Acrylic/Plastic Crystal New Mineral Glass Crystal New Sapphire Crystal New Crown/Winding Knob New Chrono Pusher Button New Case Back
Inquiring about more than one PART, please specify in this area using the information in the drop-down box above.	Please specify ALL the parts you are inquiring about (here).
Questions or Comments?	Enter questions or comments (here).

ATTENTION: If you believe your watch may need service, in addition to a new part(s), you may wish to submit our 'free' watch repair estimate form - CLICK HERE. 

Please be advised that we only sell parts when they are installed on your watch by us.  Your part inquiry will result in one of the following responses:

1. A request for you to provide more detailed information.

2. A "ball-park" estimate, which is a non-binding "best guess" of the availability and cost to install the part on your watch.

3. A request for you to send the watch for a formal evaluation (a firm repair quote).

After submitting this form (by clicking on the secure submit below) you MAY Receive a response, usually within 72 hours; however, some part inquiries may require more time.  please understand that we reserve the right not to respond to some inquiries which lack necessary information or are requesting services that we are unable to provide.  Thank you for your cooperation & understanding.

LEGAL NOTICE: THIS FORM IS NOT A BINDING SERVICE CONTRACT & WE ARE UNDER NO OBLIGATION TO RESPOND TO YOUR INQUIRY.  THIS IS A FREE SERVICE TO ASSIST YOU, WHEN POSSIBLE, IN GAINING MORE INFORMATION ON THE POTENTIAL TO SERVICE YOUR WATCH. 
Entering false or misleading information about your identity in any of the above fields may constitute a crime under The Identity Theft & Assumption Deterrence Act.