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 to #: 626-810-2166
PART #
DESCRIPTION
QTY
PARTS REQUEST FORM
19
Summary of Contents for 555LXT
Page 2: ......
Page 5: ...LABEL PLACEMENT 3...
Page 7: ...OVERVIEW DRAWING 5...
Page 8: ...HARDWARE TOOLS LIST 6...
