TimeCareinc.com - Shipping Repair Order Form Print clearly. Please complete, sign and send this form with your watch. Name:_________________________________________________ Address:_______________________________________________ City:______________ State:________ Zip:______________ Home Phone:____________ Work Phone:______________ Cell Phone:______________ Email Address:________________ Watch Brand:_____________________ Model:_____________________________ Watch Metal ( gold, silver, stainless):_____________ Serial#:_________________ Type of band( leather, metal ):___________________________________________ Description of watch (color of dial, bezel, sapphire crystal, acrylic etc.): ___________________________________________________________________ Repair request: clean oil and adjust, crystal, tube crown, refinishing etc. Describe what problems you are having in detail:_____________________________ ___________________________________________________________________ ___________________________________________________________________ When was last service?_____________________ Is watch running now? Yes or No:______ Please pack all watches in foam or bubble wrap in boxes only. Send watch only and completed watch repair form, no manufacturers boxes. Declared Value - this is the amount that we will use to send watch back to you: $_________ If sending more than 1 watch include repair form for each watch. Please send to the following address: Time Care Incorporated P.O. Box 7489 Seminole, Florida 33775 Phone number: 727-215-8870 Fax: 727-392-8793 Email: rikki.234@hotmail.com Thank You!