This Form is for printing out and filling in by hand.

 If you are using Internet Explorer, Firefox, Adobe Reader, or Google Chrome and want a PDF form that you can fill out on your computer click here.  SendingWatchForm2013.pdf

Before you fill out this form, please go to my web site and check to be sure that I am accepting watches at this time.

I work out of my house and do not have a retail shop. This means that you will have to mail your watches to me for repair, yes even if you live in the Portland area. Thank you for your understanding in this matter.

Due to the number of watches I receive, I can quickly get too many watches to repair in a timely manner. So please ask first before sending me any watch, as I do not repair all makes of watches and may not be able to acquire parts for your watch, and may not be accepting watches at this time.

It really does help in diagnosing your watch, so please complete the following form in its entirety, and enclose a completed form with each watch that you wish to have repaired. Please do not send more than two watches without asking first.

When sending me your watch(es), please do not just throw them in a box without padding. If you are using a padded envelope, use two padded envelopes. I also suggest not mailing your watches in presentation boxes, as they cost much more to mail. Please consider the environment when choosing packing materials. Plastic bags, bubble wrap, plastic-lined envelopes, and Styrofoam cannot be successfully recycled and will eventually end up in a landfill-forever. Newspaper and other clean, used paper can be recycled and composted. So in an effort to cut down on waste, all customers who package their watches without the use of plastic materials (newspaper in a cardboard box works very will for most watches) will receive a $5.00 discount on any repair you authorize.

Include a check, money order, or plastic authorization, made out for $20.00. The twenty dollars covers diagnosis and return shipping for up to three watches with $500.00 postal insurance. If you require more than $500.00 insurance on return shipping, the cost will be $2.00 for each $500.00 insurance more than the initial $500.00.

Do you want more than 500.00 insurance on this watch? Yes_____ No _____ How much insurance do you want? ______________

To prevent watches from just being thrown on my porch,  send watches with a signature required to this address:    Q. W. R.   3641 S. E. Morrison Street   Portland, Oregon 97214  

I will ship your watch(es) back to you by Registered Insured US Mail with a signature required.     Enter the address you want the watch shipped to:

Name:_____________________ Street:_______________________________________________________

City:______________________ State:______  Zip:__________

It is quite often much more efficient for me to call you. Please include your telephone number


Please: using block letters, enter your e-mail address twice for accuracy, and turn off your spam blocker for my e-mail address so I can e-mail you:

Your e-mail address:___________________________________________________________________

Your e-mail address:___________________________________________________________________ 

Watch Brand and Model_______________________________________________________________

Have your noticed condensation in your watch ____Yes ____No

Does the date or calendar function work properly ____Yes ___No Chronograph ___Yes ___No

Is your watch running slow___ how slow___________ fast ___ how fast ____________

Do you expose your watch to Rain ____ Shower ____ Swimming____ Diving ____ If diving how deep _______

Description of repair or service required: _________________________________________________________________________________________________________________________________


I accept Checks, Visa, Master Card, and American Express. I do not take Discover Card.

Please enclose credit card details, or a check for 20.00, to cover diagnostics and return shipping for up to two watches by registered insured mail.

Please use block letters and enter your credit card number twice for accuracy.             Your Signature: _________________________________

Credit card number: __________________________ Expiration month: _____ Year: _____ CID Code ____

Credit card number: __________________________ Expiration month: _____ Year: _____ CID Code ____

(Credit card details above the $20.00 diagnostic and shipping fee will only be used upon completion of repair).  

Billing address if different from shipping address:

Name:______________________ Street: _________________________________________________

City: ____________________ State: __________ Zip: _______ Telephone _______________________

Also it takes a good deal of time to answer your e-mailed questions, so do us a favor and turn off your spam blocker for  and please empty your mail box so my reply doesn't get sent back to me.