Fitness Reality AIR WALKER 2409 Manuale d'uso - Pagina 15
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PART REQUEST FORM
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: _________________________________________
PART #
DESCRIPTION
QTY
"YOUR ORDER WILL BE PROCESSED WITHIN 3 BUSINESS DAYS"
*This form can also be faxed to #: 626-810-2166
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