WATCH REPAIR REQUEST FORM
USA WATCH SERVICE
2 Washington St. Suite J2
Dover, NH 03820
Tel. (603) 742 0001
Fax. (603) 742 1150


Customer Information :

Please fill in the form, print it and send it along with your watch.
Your watch will be returned to this address by US Mail. A Signature will be required when
your watch is returned.

Name.....................................................

Customer Address................................

City........................................................

State......................................................

Zip.........................................................

Daytime Phone.....................................

Email Address......................................

Brand of Watch....................................

Model/Serial Number (if known)........

Please describe the problem you are having (be specific):