This Form is for printing out and filling in by hand.

 If you want a PDF form that you can fill out on your computer click here.    sendingwatchform1-12Page1.bak.pdf

 

I work out of my house and do not have a retail shop. That means you will have to mail your watches to me for repair, yes even if you live in the Portland area. Thank you for your understanding in this matter.

Please complete the following form in its entirety, 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.

When sending me your watch(es) please, do not just throw them in a priority box without padding. If you are using a padded envelope, use two padded envelopes. I also suggest not mailing your watches in the large presentation boxes as they just cost a lot more to mail.

Include a check, money order, or plastic authorization, made out for $20.00. The twenty dollars covers diagnosis, and return shipping for up to three regular size watches with insurance of $500.00 dollars. If you require more than $500.00 insurance on return shipping include $2.00 for each $500.00 insurance more than the initial $500.00.

To prevent watches from just being thrown on my porch,                           Q. W. R.

send watches with a signature required to this address:                             3641 S. E. Morrison Street

                                                                                                                                       Portland, Oregon 97214

 

I will ship your watch(es) back to you by Registered Insured US Mail with a signature required.

Enter the address you want the watch shipped to:

Name:_____________________ Street:__________________________________________________

City:______________________ State: ____Zip:_______ Telephone:___________________________

Please using block letters, enter your e-mail address twice for accuracy, and turn off your spam blocker for my e-mail address so I can e-mail you: jpaulson@earthlink.net

e-mail address:______________________________________________________________

e-mail address:______________________________________________________________

Watch Make and Model_______________________________________________________________

Have your noticed condensation in your watch ____Yes ____No

Does the date or calendar function work properly. ____Yes ___No Chronograph ___Yes ___No

Is your watch running slow___ how slow___________ fast ___ how fast ____________

Do you expose your watch to Rain ___ Shower ___ Swimming___ Diving ___ If diving how deep ___.

Description of repair or service required: ______________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________

I accept Checks, Visa, Master Card, and American Express. I do not take Discover Card

Please use block letters and enter your credit card number twice for accuracy, or enclose a check for 20.00 to cover diagnostics and return shipping for up to three watches by registered insured mail.

Credit card number: ____________________ Expiration month: _____ Year: _____ CID Code ____

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: __________________________________

Billing address if different from shipping address:

Name:_______________________ Street: _______________________________________________

City: ____________________ State: __________ Zip: _______ Telephone ____________________

It takes a good deal of time to answer your e-mailed questions, so do us a favor - turn off your spam blocker for jpaulson@earthlink.net and please empty your mail box so my reply doesn't get sent back to me.