Johnson Jewelers Repair Request Form

JOHNSON JEWELERS Jewelry Repair Request Form

Fill out completely, including entering your initials at the bottom to indicate you agree with the terms. One form per item. This form is only required if you plan to use the curbside service.
Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email
example@example.com
Preferred method of contact

PhoneEmailText
Item type

RingChainPendant/CharmBraceletEarring(s)Brooch/PinBead/Pearl Strand
To determine our liability limit, please provide the value range of your item.

Under $500$501 - $1000$1001 - $2000$2001 - $5000$5001 - $9999
*Values of $10,000 and over will require documentation and advance approval. Please call to discuss.*
Describe the repair or modification requested:
Is there anything special we need to know, eg. requested completion date, any specific concern or other request?
Would you like an estimate of the cost before proceeding with the work?

YesNo
If No please provide approval to proceed up to a dollar amount:
We will contact you if needed after a full examination of your item.
Agreement:
I understand that Johnson Jewelers will have a limited ability to examine my item upon drop off. I ask Johnson Jewelers to be reasonably responsible for my item as described above and understand that their professional opinion of value may differ from my stated value. I agree Johnson Jewelers will have the opportunity to notify me of a change in the accepted liability limit, and that they will contact me (if I requested) to provide an estimate of the proposed work and fees. I agree to compensate Johnson Jewelers for the agreed upon fees at completion, and will not expect them to remain responsible for my item after 60 days. I understand that Johnson Jewelers is not offering to act as an insurer of my item.
Enter your initials here to indicate you have read and agree to the statement above:*
Date

MonthDayYear
Date
Should be Empty:

Agreement: