Repair Request Form

Repair Request Form
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email
example@example.com
Return Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Description of Watch*
(ex. watch model, special additions/identifiers, etc)
Description of Issue*
(ex. Watch not keeping time, Hands Loose, etc)
Approximate Original Receipt Date of Timepiece

MonthDayYear
Date
*Please be sure to include a $19.00 check for return shipping charge.

Return watch to our service center located at:

Selco Repairs

8909 E 21st Street

Tulsa, OK 74129
Should be Empty: