21
Paradigm
Health & Wellness
, Inc.
EMAIL THIS FORM WITH YOUR RECEIPT OF PURCHASE TO
NAME:
______________________________________________________________________
ADDRESS:
__________________________________________________________________
CITY:
________________________
STATE:
_____________
ZIP:
________________________
TELEPHONE:
(Day)
_________________________________________________________
(Night)
________________________________________________________
SERIAL#:
____________________________________________________________________
MODEL#:
____________________________________________________________________
PURCHASE DATE:
____________________________________________________________
PLACE OF PURCHASE:
________________________________________________________
“YOUR ORDER WILL BE PROCESSED WITHIN 3 BUSINESS DAYS”
*This form can also be faxed to #: 626-810-2166
PART #
DESCRIPTION
QTY
PARTS REQUEST FORM
Summary of Contents for 2636
Page 5: ...3 LABEL PLACEMENT ...
Page 7: ...5 OVERVIEW DRAWING ...
Page 10: ...8 HARDWARE TOOLS PACK ...