LACOSTE 3-HAND Series Operating And Maintenance Original Instructions page 17

LACOSTE WATCHES SERVICE REQUEST FORM A
Name _________________________________________________
Address ________________________________________________
City __________________________________________________
State/Province ___________ Country ___________ ZIP/Postal Code ___________
E-mail _______________________ Phone (_____)_________________
Watch Model _____________________________________________
What needs service, replacement or repair: _______________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
___________________________________________________
____________________________________________________
__________________________________________
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LACOSTE WATCHES US/CANADA SERVICE REQUEST FORM B
Include with all service requests sent to LACW Service Centers in the U.S. or Canada
ITEM
Battery
Shipping
& Handling
TOTAL:
Payment method:
___ Check or Money Order
___ MasterCard
___ Visa
Account number: ________________________________
Expiration date: _________________________________
Signature: _____________________________________
(Required for credit card purchases)
OBTAINING SERVICE
PRICE
$35.00 USD/
$35.00 CAD
$15.00 USD/
$15.00 CAD
17
TOTAL
$__________
$15.00 USD or
$15.00 CAD
$_________