It's About Time! Watch Repair

Watch Repair Authorization Form

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

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 Wisconsin Wyoming Yukon Territory

Zip

Country

Email

Home Phone

Cell Phone

Payment Information

You may pay by check or money order. Please make out to: Scott A. Ekleberry

Type of Timepiece : Chose one Wrist Watch Closed Face (Hunter) Pocket Watch Repeater Chronograph Open Faced Pocket Watch Seiko Kinetic 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 Titanium Unknown Water Resistance Level: Chose one Water-Resistant Waterproof Neither Unknown Brand: Model:

Serial Number and/or case number:

Active member of the US Armed Forces? (yes or no):

SERVICES REQUESTED

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

Please submit a separate and complete repair form for each watch you are shipping.

By signing this form and sending your watch you are agreeing to the following:

• The information you have provided is accurate to the best of your ability.

• It's About Time! Watch Repair is not responsible for any loss or damage to your watch during shipment to me.

• You are responsible for insuring you timepiece and packaging it adequately so that it arrives safely.

• While I may provide an estimated completion date I can not guarantee that date. I will do my best to meet and exceed your expectations but service times may be delayed for a number of reasons that are out of my control.

• Even if the repair is not successful, you may be asked to at least pay for the cost of parts and/or labor used on your watch.

• Any watch not paid in-full after repair completion shall become the property of It's About Time! Watch Repair after 90 days unless prior arrangements have been made.

•  Estimate fees must please be sent along with the watch.
  

 

Signature:______________________________________________ Date: __________________________

  

I cannot give you any estimate until I have seen your watch; your understanding is appreciated.

 

Please mail with watch and payment to:

Scott A. Ekleberry - Watchmaker

It's About Time! Watch Repair

PO Box 22

Upper Sandusky, OH 43351