The Last Wind-Up

Repair Form

Each timepiece sent MUST have its own Repair Form.

For each timepiece you send. Please:
  • Fill in this form.
  • Click the Submit Request button.

Shipping and contact information:
* First Name:
*Last Name:
* Street 1:
Street 2:
Street 3:
* City, St, Zip:    
* Email:
Phone (*1st):
ex 4062223333
  (2nd)   (Fax)
Return Ship Via

Information about the repair:
*Manufacturer: (Enter NA if not known.)
*Value  $: (Return shipment insured value)
*Timepiece problem and/or notes to us:
 E-mail me a cost estimate before work begins?   Yes No
*Click this button for next step --->