Personal Information  

          First Name 

M.I.

Last Name

         Work Phone Number

Email Address

          If you select a clock as your award, please provide a physical address below for UPS delivery.  All other awards will be presented to you by your supervisor.

          Street Address (No P.O. Boxes, please.)

Suite or Apartment Number

          City

ST

ZIP

          Please enter the PIN as shown on the label on the back of your selection sheet.

     Please answer the following questions regarding your selection.

     1.   Please enter your award selection using the drop down menu below.

          Award selections #1.     Seiko Men's Diamond watch #2.     Seiko Ladies Diamond watch #3.     Howard Miller Sandringham wall clock #4.     Howard Miller Maxwell wall clock #5.     Seiko SNAC75 Men's Chronograph #6.     Canon PowerShot digital camera #7.     KM Leather Collection

     2.  If you selected a Howard Miller clock, please choose from the following engraving options:

          None Your name, years of service and company name Name only

     3.   It you selected a Seiko watch, please choose from the following engraving options:

          None Your initials, years of service and company name Initials only

     4.  If you requested engraving, please provide the name (Howard Miller clocks) or initials (for the Seiko watches) that you would like engraved