PART REQUEST FAX FORM
Fax this form to 1-626-810-2166
Or email customer service requests to : service@paradigmhw.com
NAME: ________________________________________________________________
ADRRESS: ______________________________________________________________
TELEPHONE: (day ) ______________________________________________________
(night ) _____________________________________________________
(fax )_______________________________________________________
MODEL #: ______________________________________________________________
PURCHASE DATE: ________________________________________________________
PLACE OF PURCHASE: ____________________________________________________
Part #
* YOUR ORDER WILL BE PROCESSED WITHIN 3 BUSINESS DAYS
SHIP DATE: _______________________________________________________
TRK # : ___________________________________________________________
BACK ORDER: _____________________________________________________
Description
OFFICIAL USE ONLY
3
Quan.