Service Parts Form - Champion 54P Series Operating Instructions And Service Manual

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

SERVICE PARTS FORM

Please duplicate form for use
Purchase order #: ______________
Page no. / part no.
Champion Manufacturing Inc.
2601 Industrial Parkway
Elkhart, IN 46516
Phone: 800-998-5018 fax: 574-293-5760
Shipping instructions:
Ground: ______
3 rd
2 nd
Next day: _____
No order will be processed
without a P.O. & SN number.
Quantity
(25)
OM00PWR Power Recliner Manual REV 1 010118
day: _______
day: _______