Print Form

Owner Identification Form

Date Shipped to us ______________________

Name ________________________________
Address ______________________________
City _______________ St. _____  Zip______

Daytime phone number  (____) ____ - ________
Evening phone number   (____) ____ - ________
E-mail Address _________________________

Description of problem as best as you can describe.  ___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________

Numbers on weights   _______   _______
OR
Length of weights      _______   _______

 If you have an 8 day clock with music, YOU MUST CALL before sending it.