Paradigm Health & Wellness, Inc.
EMAIL THIS FORM WITH YOUR RECIEPT 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 in Fax #: 626-810-2166
PART #
DESCRIPTION
QTY
PART REQUEST FORM
21
Summary of Contents for 1302.4
Page 2: ......
Page 5: ...LABEL PLACEMENT 3...
Page 7: ...OVERVIEW DRAWING 5...
Page 9: ...HARDWARE PACK 7...