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# 7101
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
001 Main Frame 400x320x279
002 End Cap (□25x50)
003 Motor
004 Bolt M6x12mm
005 Spring Washer Ø6.5xØ10.5x1.4T
006 Right Cover 395x316x77
007 Left Cover 395x316x73.5
008 Power Control Board
009 Screw ST2.9x6.5mm
010 Controller
011 AC Power Cable 2.07M+SR
012 Display
013 Bolt M5x10mm
014 Screw ST4.2x15mm
015 Right Crank 4" (9/16")
016 Left Crank 4" (9/16")
017 Bolt M8x20mm
018 Plastic Cap Ø26x8
019 Left Pedal JD-32A (9/16")
020 Right Pedal JD-32A (9/16")
021 Round Magnet Holder
022 Round Magnet
023 Strap
024 Handle
025 Washer Ø6.5xØ13x1.5T
026 Square Sensor
027 Non-slip Mat
 

"YOUR ORDER WILL BE PROCESSED WITHIN 3 BUSINESS DAYS"

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