Request Repair

You may complete, print and mail this form with your repair. This Form is provided for your convenience, but any means of conveying the same info will do. The information filled in below is not being transmitted over the Internet in any way.

* Indicates Required Field

Your Information

Billing Info

Please enter your billing information below as it appears on your credit card statement.

First Name: * Last Name: *
Address 1: *
Address 2: *
City: * State: * Zip Code: *

Contact Info

We will notify you of estimates via e-mail. If you do not have an email address, we will send your estimates via regular postal mail or phone.

E-Mail Address:
Daytime Phone Number: *
Evening Phone Number: *

Shipping Info

Leave the following section blank if your shipping address is the same as your billing address. We cannot deliver to P.O. boxes, please enter physical mailing addresses only.

First Name: Last Name:
Address 1:
Address 2:
City: State: Zip Code:

Repair Item Information

Describe the item you're sending in for repair:
Serial Number:

Comments/Services Requested:

It helps the watch or clockmaker to have as much information as possible about what the timepiece is doing or not doing. If this form is being used for crystal replacement, jewelry work, etc., please state. Also, please indicate "Special Offers, WARRANTY ISSUES or Promotions" here.

(limit 1,000 characters)

Payment Method

If paying by check or money order, please make it out in the amount of $20.00 (USD) payable to Old Time Watch & Clock Shop.

Personal Check or Money Order Enclosed
Visa MasterCard

Credit Card Number:
Exp. Date:
Signature: (signature required)

There is a $20.00 return shipping/insurance/handling cost. You can review our repair warranty here.

Our Shipping Label

For USPS Registered Mail, complete, clip-out, secure this label to your package.

From:

Old Time Watch & Clock Shop
480 Memorial Pkwy Ste B
Phillipsburg NJ 08865-1551

Print Your Work Order & Shipping Label

1) Just use Your Browser's "Print" button (above in your toolbar) to print this form, and send it along with your repair item.

2) Sign the credit card information section and double-check the card number and expiration date entered.

3) Cut out the shipping label above and affix it to your package securely. Depending on your printer, you may have to highlight the shipping label and choose "Print Selection" from your browser to force the form to print on one solid page.

4) Include your work order form in the box when shipping your repair/restoration items.

Thank you for your business.