Repair Request Form

Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Preferred contact method*

PhoneEmail
IMPORTANT - PLEASE READ:

Upon receiving this completed form, a member of our Customer Service team will follow-up with you to discuss the next steps.

Do not send your writing instruments until instructed to do so.

Thank you for writing with Retro 51.
Writing Instrument No. 1: Name - Model*
Please note the name of the writing instrument (ie. Dr. Gray Vintage Metalsmith) and the model (ie. Tornado Rollerball, Hex-o-matic, etc.)
Writing Instrument No. 1: Issue Details*
Please note any specific issues you are experiencing with your writing instrument, including detailed comments on hardware, appearance and usability.
Writing Instrument No. 1: Was it purchased within 1 year from today's date?*

Yes, it has been 1 year or lessNo, it has been over a year +
Writing Instrument No. 1: Where did you make the purchase?*
Please note which one of our retailers you purchased this from (ie. Dromgoole's, Goldspot, etc.)
Do you have an additional writing instrument that needs repairs?*

Yes, Please!No, Thank you!
Writing Instrument No. 2: Name - Model*
Please note the name of the writing instrument (ie. Dr. Gray Vintage Metalsmith) and the model (ie. Tornado Rollerball, Hex-o-matic, etc.)
Writing Instrument No. 2: Issue Details*
Please note any specific issues you are experiencing with your writing instrument, including detailed comments on hardware, appearance and usability.
Writing Instrument No. 2: Was it purchased within 1 year from today's date?*

Yes, it has been 1 year or lessNo, it has been over a year +
Writing Instrument No. 2: Where did you make the purchase?*
Please note which one of our retailers you purchased this from (ie. Dromgoole's, Goldspot, etc.)
Supporting Image Upload

If applicable, please upload any images that will help our team determine the repairs needed, including cracks or damaged parts.
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Who directed you to this repair form?

Lupe S.Sarina O.Deana V.Jeff V.Social MediaRetro51.comOther
Customer Service

Call: 972-479-1405

Email: customerservice@retro51.com
Please verify that you are human and not a robot*
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