Guess 10179G Booklet page 47

Please complete this form and enclose it with your carefully packed watch
for repair. Add a money order for $7.50 (postage and handling). If paying by
VISA or MASTERCARD, please see below.
NAME:
ADDRESS:
STATE / CITY:
PHONE#:
BATTERY
NON-WATERPRO CASE/CRYSTAL
®
SHIPPING/HANDLING
TOTAL CHARGES
(Residents of CT & NY please apply appropriate sales tax)
TOTAL CHARGES (with sales tax if applicable) ____________
Total charges may be paid with VISA or MASTERCARD or money order. If
paying by charge card, please fill-in below.
Please do NOT send cash.
VISA
CARD#
EXPIRATION DATE
WATCH REPAIR
ZIP CODE:
DATE SENT:
PRICE EACH
$4.00
$10.00
$7.50
____________
MASTERCARD
SIGNATURE
12
TOTAL PRICE
____________
____________
$7.50
____________
____________
47 care & Warranty