Online Warranty Registration Form

Thank you for purchasing an orbichron^® clock.  Please take a moment to help us by answering the following questions:

How did you become acquainted with the orbichron clock line of products?

Store Display

Web Site

Print Advertisement

Word of Mouth

Other

Do you wish to be notified regarding new products?

Yes, by Mail

Yes, by Email

No

Did you receive this orbichron clock as a gift from another, or did you purchase it for yourself?

Received as Gift

Bought for Myself

Is this the first orbichron clock you have owned?

Yes

No

Do you plan to use this in your home or office?

Home

Office

Where did you purchase this product?

Brick & Mortar Store

On-Line e-Store

Store
City		State/Province
ZIP/Postal Code		Country

 

* Indicates required fields.

Select the orbichron clock model you are registering:

Black Case w/Chrome Legend - Model ODC-108D-SA-BC Black Case w/Gold Legend - Model ODC-108D-SA-BG Chrome-Plated Case w/Chrome Legend - Model ODC-108D-SA-CC Gold-Plated Case w/Gold Legend - Model ODC-108D-SA-GG Tortoise Shell Case w/Gold Legend - Model ODC-108D-SA-TG *

Enter the serial number for this clock: *

Please enter the personal information below:

Name	*
Title
Company
Address	*
City	*
State/Province	*
Zip/Postal Code	*
Country	*
Email	*
Phone	*

Please enter any comments you wish to make: