11
PARTS REQUEST FAX FORM
PARADIGM
PARTS REQUEST FAX FORM
Please fax this form to (1-626-810-2166)
OR YOU CAN EMAIL CUSTOMER SERVICE REQUESTS TO
NAME: ____________________________________
ADDRESS: ___________________________________
TELEPHONE: (Day) ________________________________
(Night) ____________________________________________
(Fax#, if available) __________________________________
MODEL#: __________________________________________
PURCHASE DATE: _________________________________
PURCHASE FROM: _________________________________
"YOUR ORDER WILL BE PROCESSED WITHIN 3 BUSINESS DAYS"
OFFICIAL USE ONLY
SHIP DATE: ________________________________________
TRK #: ___________________________________________
BACK ORDER: ________________________________________
PART # DESCRIPTION
QTY
