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First Name:

Last Name:

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Email:

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Watch Brand:
Seiko, Breitling, etc.

Model #:

The MODEL # is a NUMBER usually on the case back. NOT a popular name for the watch.

Serial #:

Age of Watch:

Style:

Movement Type:

Case Color:

Water Resistance:

Bathe or Swim w/watch?:

Last Repair:

How long ago was last repair?:

Is your watch running now?

Comments:

(If sending additional watches, briefly specify watch brand and problem here)

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