Exerpeutic Elliptical - Fax Form; Parts Request Fax Form

Paradigm Health & Wellness, Inc.
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: ________________________________________
FAX FORM
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