Exerpeutic Inversion Table - Parts Request Fax Form

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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: ________________________________________

FAX FORM