Motion Works Antique Clock Repair
7552 Pierce Street.
Arvada, Colorado. 80003-2815
Local 303 456-7958 Toll Free 1-888-456-7958
Customer Order Form.
Customer name: _____________________________________
Mailing Address: _____________________________________
City_______________________, State________________ Zip Code: __________
Phone # Home: ___( )_______________________________
Work Number: ___( )_______________________________
E-Mail Address: __________________________________
Make of Clock(s): _________________________________
Services Requested: ____________________________________
Number of items packed: ________________________________
Items enclosed: (key, hands, pend. bob, pendulum, etc.) ________________________
____________________________________________________________________
Notes: _______________________________________________________________
_____________________________________________________________________
***By signing this order form, you agree to be in compliance and have fully read and understand the warranty and
policies, the conditions there of, pricing and terms of agreement listed on the FAQ's page of this web site.***
Customer signature: ______________________________
Date: ___________________