Exerpeutic 1020 - Parts Request Fax Form

22
PARADIGM
PARTS REQUEST FAX FORM
Please fax this form to (1-626-810-2166)
OR YOU CAN EMAIL CUSTOMER SERVICE REQUESTS TO
service@paradigmhw.com
NAME: ________________________________________________________________
ADDRESS: _____________________________________________________________
CITY ______________ STATE ______________ ZIP __________________
TELEPHONE: (Day) ______________________________________________________
(Night) _____________________________________________________
(Email Address) _____________________________________________
SERIAL#: __________________________________________________
MODEL#: __________________________________________________
PURCHASE DATE: ______________________________________________________
PURCHASE FROM: ______________________________________________________
“YOUR ORDER WILL BE PROCESSED WITHIN 3 BUSINESS DAYS”
PART #
DESCRIPTION
QTY
OFFICIAL USE ONLY
SHIP DATE: ___________________________________________
TRK #: _______________________________________________
BACK ORDER: ________________________________________