Exerpeutic EXERWORK 1000, Owner'S Manual

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PARTS REQUEST FORM
Paradigm Health & Wellness , Inc.
EMAIL THIS FORM WITH YOUR RECEIPT OF PURCHASE TO
Service@paradigmhw.com
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