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
31
