Watch Repair Form

Customer Information

Full Name

Address

City

State Choose a State Outside US / Canada Alabama Alaska Alberta American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific British Columbia California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northern Mariana Is Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Palau Pennsylvania Prince Edward Island Province du Quebec Puerto Rico Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin ISlands Washington West Virginia Wisconson Wyoming Yukon Territory

Zip

Country

Email

Home Phone

Cell Phone

Payment Information

Visa MC Discover Check Payment Amount

Account#

Exp.(mm/yy) CVV

Signature

Your credit card will be charged only for an estimate fee. If further work is approved then you may authorize us to charge the remainder on the same credit card or choose another payment method.

You may pay by check if you wish. Please make out to: Masterpiece Watch Restoration

How did you hear of us : Chose one Search engine Prior customer Referring web site Magazine Brochure Referring watchmaker Email Direct link clicked advertising Friend Referrel

Type of Timepiece : Chose one Wrist Watch Pocket Watch Repeater Chronograph Fusee Clock Chronograph Open Faced Pocket Watch Age of Timepiece : Chose one less than 5 years old 5 - 15 Years 15 - 25 Years 25 - 50 Years 50 - 100 Years 100 Years and over

Metal : Chose one 10 K Gold 14 K Gold 18 K Gold 24 K Gold Gold Filled Sterling Silver Stainless Steel SS & Gold White Gold Platinum TitaniumWater Resistance Level: Chose one Water-Resistant Waterproof Neither Don't know Are you interested in selling this or another timepiece : Chose one Yes No Maybe Brand: Model:

Service's request:

Insurance Value $__________________________ *OUR MAXIMUM LIABILITY FOR THIS ITEM IS $100.00 UNLESS A SPECIFIC VALUE IS STATED HERE

 

You must submit a separate and complete Repair form for each watch you are shipping.

Please package your watch in a box - no padded envelopes please. Do not include your original box, paperwork or any other packaging you may want back. We recommend and ship by Registered US Mail. We will contact you upon completion of the estimate. We encourage you to include your email to expedite the delivery of your estimate or communication concerning your timepiece.

By signing this form and sending us your valued timepiece you are agreeing to the following: The information you have provided is accurate to the best of your ability. Masterpiece Watch Restoration LLC is not responsible for any loss or damage to your watch during shipment to us. You are responsible for insuring you timepiece and packaging it adequately so that it arrives safely. We do not Rush our work, it is more important for us to do quality work. While we may provide an estimated completion date we can not guarantee that date. We will do our best to meet and exceed your expectations but service times may be delayed for a number of reasons that are out of our control, including but not limited to the following: Difficulty in obtaining or fabricating Vintage parts, parts temporarily out of stock, delays in receiving ordered parts, holiday and other seasonal delays.  Any watch not paid for after completion (repair or estimate) shall become the property of Masterpiece Watch Restoration LLC.  after 90 days unless prior arrangements have been made.

 

Signature:__________________________ Date: __________________________

 

 

We cannot diagnose the problem or give you an honest & accurate estimate without inspecting your watch.

You can type in this form and then print it out to return with your watch or
you may print the form and fill out by hand
PLEASE PRINT CLEARLY

Then mail with watch and

payment to:

Masterpiece Watch Restoration

P O Box 280542
Tampa, FL 33682

 

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