Stamina 4650 - Fax;Mail Ordering Form

FAX/MAIL ORDERING FORM
Please do not return the product. For your convenience, Stamina has a Customer Service Department
with a toll-free number. If you have a missing part or a defective part, please call 1 (800) 375-7520 (in the
U.S.) between 8:00 A.M. and 5:00 P.M. Central Time, Monday through Friday. You may fill out the order
form below and mail it or fax it to Stamina. The fax number is (417) 889-8064. You may also e-mail our
Customer Service Department at rudolph@ncsi.net . Our Customer Service Department will be able to
assist you with your problem and necessary parts will be mailed directly to your home.
Phone #: ( ) Work Phone #: ( )
Date Purchased:
Model #:
Purchased From:
Mr./Ms.:
Address: Apt. #:
City: state: Zip Code:
IMPORTANT: We must have your phone number in order to process the order!
Stamina Products, Inc.
P.O. Box 1071
Springfield, MO 65801-1071
IMPORTANT: Before filling out the form below make sure you have the right information. Refer
to the parts list to make sure you're ordering the right parts!
PART # DESCRIPTION QUANTITY
1 Rear Unit Assembly 1
EXAMPLE:
Detach and Mail or Fax the Form Below
TELEPHONE
CUSTOMER SERVICE
Tel: 1 (800) 375-7520
FAX
CUSTOMER SERVICE
Fax: (417) 889-8064
E-MAIL
STAMINA PRODUCTS, INC.
ATTN: Customer Service
rudolph@ncsi.net
MAIL
STAMINA PRODUCTS, INC.
ATTN: Customer Service
P.O. Box 1071
Springfield, MO. 65801-1071