Service Parts Form - Champion ASCENT Operating Instructions And Service Manual

Ship to:
Facility:______________________________
Address:______________________________
______________________________
City: ___________________ State_____ Zip________
Telephone: (_____) _____ / _________ Fax : (_____) _____ / _________
Reminder: if no shipping choice is made, the least expensive way will be used.
Bill to:
acility:______________________________
F
Address:______________________________
______________________________
City:____________________ State_____ Zip_________
Order placed by:
Name:________________________________
Phone: (_____) _____ / _______ Ext.: ______
Email:_____________________________________
Model number: _________________________ Serial number: _________________
Part number

SERVICE PARTS FORM

Please duplicate form for use
Shipping instructions:
Purchase order #: ______________
Page no. / part no.
Champion Manufacturing, Inc.
(24)
Ground: ______
rd
3 day: _______
nd
2 day: _______
Next day: _____
No order will be processed
without a P.O. & SN number.
Quantity
Recliner Manual REV3 040715 cam