Sending Watch Form

Sending Watch Form

http://www.qualitywatchrepair.com       jpaulson@earthlink.net              1-503-239-1859

Send watches to this address

Q. W. R.

3641 S. E. Morrison Street

Portland Oregon 97214

Please for the time being do not send your watches in the large retail watch boxes. I have run out of room for them.

Please complete the following form and enclose it with the watch you wish to have repaired. If you are sending more than one watch, please complete one form per watch.

I Will ship your watch back to you by Registered Insured US Mail with a signature required. Please use the address you want the watch shipped to.

A note on shipping your watch to me. I have had trouble with (Fed-EX ground) leaving packages on my porch without knocking.

NAME: ___________________________________Street: _______________________________________________________

City:_______________________________ State:___________ Zip:_________________ TELEPHONE: __________________________

Please Use Block Letters And Enter your E-Mail Address Twice For Accuracy

E-MAIL: ___________________________________________________________________________________________

E-MAIL: __________________________________________________________________________________________

Please turn off your Spam blocker for my e-mail address jpaulson@earthlink.net

WATCH MAKE AND MODEL:_____________________________________________________________________________

Have you noticed condensation in your watch ___Yes ___No. What water is your watch exposed to Rain___ Hand washing___ Shower___ Swimming___ Diving___ How deep ________ ?

So I am better able to time your (wind up watch). Which wrist do you wear your (wind up watch) on?_____________

DESCRIPTION OF REPAIR OR SERVICE REQUIRED: ___________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________

We accept Checks, Visa, MasterCard, and American Express. We do not take Discover Card

I have enclosed credit card details___ or I have enclosed a check for 20.00 to cover diagnostics and return shipping for up to three watches by registered insured mail.____

Billing Address if different from shipping address:

NAME: ___________________________________Street: _______________________________________________________

City:_______________________________ State:___________ Zip:_________________ TELEPHONE: __________________________

Please Use Block Letters And Enter your Credit Card Number Twice For Accuracy

CREDIT CARD NUMBER: _______________________________________________ EXPIRATION MONTH:_______ YEAR:________ CID Code______

(Credit card details above the $20.00 diagnostic and shipping fee will only be used upon completion of repair, and only after obtaining your authorization).

YOUR SIGNATURE: ____________________________________________________