Exerpeutic Heavenly, Manual

Page: 16 / 16

15
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
PART REQUEST FORM