WATCH INFORMATION FORM

Airwaybill Number ______________________________

Return To ______________________________

1. What is the Material of the Case? ____________________________

2. Is the Case Plated? Yes _______ No _______

3. Is the back of the case Plated? Yes _______ No _______

4. What is the Back of the Case Made from? ____________________________

5. How is the watch Powered? Battery ___ Auto ___ Manual ____

6. What type of Display? Mechanical___ Optoelectronic ___

7. Number of Jewels in Movement ____________________________

8. What is the Strap/Bracelet made of? ____________________________

9. What is the Value Breakout

A) Movement ______

B) Case ______

C) Strap/Bracelet ______

D) Battery ______

Total ______

10. What is the Country of Origin of the Movement? __________________________

Date ______________________________