Fitness Reality AIR WALKER 2409 Gebruikershandleiding - Pagina 15

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PART REQUEST FORM

Paradigm Health & Wellness, Inc.

EMAIL THIS FORM WITH YOUR RECIEPT OF PURCHASE TO

[email protected]

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