STORE #
DATE:
DUE DATE*
PICK UP AFTER:
Name*
Address*
City*
State:
Zip:
Phone*
Work#
Description:
Diamond
Tested*
No. of
Stones:
Metal:
Additional Desc:
Current Ring Size:

PLOT OF CENTER STONE
(If applicable):
SIZE:
mm
SIZE TO:
INSTRUCTIONS:

Repair Shop Site*
Received by:
Purchase Date:

Charge  $
Sketch of Item:


Repair Type:
2017-09-26
Store Merchandise
SKU#1

SKU#2

SKU#3

RSP#1

RSP#2

RSP#3
Customer Valuation:                                Stated value over $500 requires management approval.
Repair Order Form
Name on Warranty: