Parts Request Form - ProGear 300LS Owner's Manual

Paradigm Health & Wellness, Inc.
EMAIL THIS FORM WITH YOUR RECEIPT OF PURCHASE TO
NAME: _______________________________________________________
ADDRESS: ____________________________________________________
CITY ______________ STATE ______________ ZIP ___________________
TELEPHONE: (Day) _____________________________________________
SERIAL#: _____________________________________________________
MODEL#: _____________________________________________________
PURCHASE DATE: _____________________________________________
PLACE OF PURCHASE: _________________________________________
PART #
"YOUR ORDER WILL BE PROCESSED WITHIN 3 BUSINESS DAYS"
*This form can also be faxed to #: 626-810-2166

PARTS REQUEST FORM

Service@paradigmhw.com
(Night) ____________________________________________
DESCRIPTION
30
QTY