Parts Request Form - Exerpeutic 900XL Owner's Manual

Paradigm Health &
EMAIL THIS FORM WITH YOUR RECEIPT OF PURCHASE TO
Service@paradigmhw.com
NAME:_____________________________________________________________________________________
ADDRESS:__________________________________________________________________________________
CITY:________________________ STATE:_____________ ZIP:_______________________________________
TELEPHONE: (Day)______________________________________________________________________
(Night)_____________________________________________________________________
SERIAL#:___________________________________________________________________________________
MODEL#:___________________________________________________________________________________
PURCHASE DATE:___________________________________________________________________________
PLACE OF PURCHASE:_______________________________________________________________________
PART #
"YOUR ORDER WILL BE PROCESSED WITHIN 3 BUSINESS DAYS"

PARTS REQUEST FORM

Wellness, Inc.
*
DESCRIPTION
This form can also be faxed to #: 626-810-2166
23
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