I can not print out your form- I do not have a printer.  The 'reference' number on the warranty card is undecipherable and you will just have to look at the card. I just populated it with the first choice as nothing matched on the pull down list that us on the warranty card.  If there is any question I will expect a call.

THIS WATCH PICKS UP 5  MINUTES EVERY DAY IN TIME - IT'S RUNNING FAST.  PLEASE REPAIR - REPLACE OR REFUND.