![background image](http://html.mh-extra.com/html/champion/continuum/continuum_operating-instructions-and-service-manual_2588650023.webp)
23
OM00720 Continuum Manual Rev 2 010118
SERVICE PARTS FORM
Please duplicate form for use
Ship to:
Shipping instructions:
Facility:______________________________
Ground: ______
Address:______________________________
3
rd
day: _______
______________________________
2
nd
day: _______
City: ___________________ State_____ Zip________
Next day: _____
Telephone: (_____) _____ / _________ Fax : (_____) _____ / _________
Reminder: if no shipping choice is made, the least expensive way will be used.
Bill to:
F
acility:______________________________
Address:______________________________
______________________________
City:____________________ State_____ Zip_________
Order placed by:
Purchase order #: ______________
Name:
________________________________
No order will be processed
Phone: (_____) _____ / _______ Ext
.: ______ without a P.O. & SN number
.
Email:_____________________________________
Model number: _________________________ Serial number: _________________
Part number
Page no. / part no.
Quantity
Champion Manufacturing Inc.
2601 Industrial Parkway
Elkhart, IN 46516
Phone: 800-998-5018 fax: 574-293-5760