Paradigm Health & Wellness, Inc.

PARTS REQUEST FORM

NAME:*

Please input name.
PURCHASER'S NAME:*
   Same as Name.
Please input purchase name.
ADDRESS:*

Please input address.
Apt.#:

Please input Apt.#.
CITY*

Please input city.
STATE*

Please input state.
ZIP*

Please input zip code.
TELEPHONE: (Day)*

Please input telephone number.
(Night)
(Email Address)*

Please input email address. Example: service@paradigmhw.com
SERIAL#*

Please input serial number.
MODEL# 1110
PURCHASE DATE:
Format: mm/dd/yyyy
PURCHASE FROM:
Please provide a copy of Proof of Purchase (e.g. invoice):*   
Please select file for upload.
     I do not have Proof of Purchase but I have registered the product online.
COMMENTS:
PART# DESCRIPTION QTY
01 Rear Frame
02 Front Frame
03 Rear Stabilizer
04 Computer Bracket
05 Seat Post
06 Seat Cushion
07 Left Pedal
08 Right Pedal
09 Computer
101 Nylon Nut 9/16 UNC12(R)
102 Nylon Nut 9/16 UNC12(L)
103 Left Pedal Strap
104 Right Pedal Strap
11 Front Stabilizer End Cap
12 Seat Post Plastic Bushing
13 Tension Control Knob
14 Seat Height Adjustment Knob M16
15 Connection Wire A
16 Front Frame Support Tube
17 Computer Post
18 Left Shroud
19 Right Shroud
20 Top Shroud
22 Safety Pin A
23 Left Crank
24 Right Crank
25 France Nut
26 Crank Cover
27 Phillips Round Head Drilling Screw M4x20
28 Phillips Round Head Tapping Screw M4x20
29 Hexagon Nut Cap M8
30 Curve Washer Ø8.2xØ22.2
31 Hexagon Socket Bolt M8x45L
32 Flat Washer Ø8.2xØ25x1.5t
33 Flat Washer Ø8.2
34 Nylon Nut M8
58 Hexagon Socket Bolt M8x15
59 Rubber Cushion
62 Safety Pin B
73 Hexagon Socket Bolt M6x12
74 Spring Washer Ø6.2
77 Back Cushion
78 Back Frame
80 Spring Washer Ø8.2
81 Carriage Bolt M8x50L
82 Handlebar
83 Hexagon Socket Bolt M8x40L
84 Wheel Cap
85 Front Stabilizer
91 Hand Pulse Wire
92 Connection Wire B 350MM
93 Connection Wire C 330MM
94 Connection Wire D 270MM
98 Front Frame Support Tube Holder
HW Hardware Pack
Tool Tool to replace cranks
 

"YOUR ORDER WILL BE PROCESSED WITHIN 3 BUSINESS DAYS"

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