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# 7102
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
002 Stabilizer Ø50x1.5tx380
003 Non-slip Mat 500x600
004 End Cap for Stabilizer
005 Right Cover
006 Left Cover
007 Digital Display Computer
008 Belt Pulley
009 Bearing 6003
010 Inner C Ring
011 Screw ST4x16mm
012 Tension Control Knob
013 Square Sensor
014 Spring Washer M8
015 Bolt M8x16mm
016 Right Foot Pedal
017 Left Foot Pedal
018 Belt (220J, 3V)
019 Right Crank
020 Left Crank
021 Plastic Cap
022 Bolt M4x10mm
023 Bolt M5x10mm
024 Bearing Bracket
025 Spring 1.0txØ10x50mm
026 Round Magnet
027 Magnet Bracket
028 Nut M10
029 Bolt M8x40mm
030 Cap Nut M8
031 Cap Nut M6
032 Washer M6
033 Bolt M6x35mm
034 Flywheel
035 Bearing 6900
036 Flywheel Axle M10x75mm
037 Plastic Washer M10
038 Adjustable Bolt M6
039 U Bracket
040 Washer M10
 

"YOUR ORDER WILL BE PROCESSED WITHIN 3 BUSINESS DAYS"

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