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# 4100
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 Front Frame
02 Rear Frame
03 Rear Stabilizer
04 Handlebar
05 Seat Post
06 Seat Cushion
07 Left Pedal
08 Right Pedal
09 Computer
10 Wire Plug
11 Rear Stabilizer End Cap
12 Seat Post Bushing
13 Tension Control Knob
14 Seat Height Adjustment Knob
15 Tension Cable
15A Clip
16 Oval Wire Plug
17 Handlebar Foam Grip
18 Left Cover
19 Right Cover
20 Top Cover
21 Plastic Bushing
22 Safety Pin
23 Left Crank
24 Right Crank
25 Flange Nut
26 Crank Cover
27 Round Phillips Head Drilling Screw M4x20
28 Round Phillips Head Tapping Screw M4x20
29 Hexagon Nut Cap M8
30 Curve Washer Ø8.2xØ22.2
31 Front Stabilizer Ø50x1.5tx550L
32 C-ring Ø10
33 Flat Washer Ø8.2xØ16.8
34 Nylon Nut M8
35 Magnet Bracket
36 Washer Ø6.2
37 Sensor Wire
38 Flywheel
39 Belt Wheel with Crank Axle
40 Bearing Bracket A
41 Wave Washer
42 Bearing
43 C-ring Ø17
44 Belt Wheel
45 Bearing 6000Z
46 Axle Ø12.8x94L
47 Eyebolt M6
48 Tension Bracket
49 Support Tube Holder
50 Nylon Nut M6
51 Nut M10
52 Washer Ø10.2xØ25
53 Wave Washer Ø17
54 Idle Wheel Axle
55 Nylon Nut M10
56 Bearing 6902Z
57 Axle Ø15.8x94.5L
58 Hexagon Socket Bolt M8x15
59 Rubber Cushion
60 Washer Ø8.2x Ø25x2.0t
61 Flat Phillips Head Screw M6x10
62 Holder
63 Round Phillips Head Screw M4x10
64 Plastic Washer
65 C-ring Ø15
66 Screw M4x10L
67 Rear Frame Support Tube
68 Screw M5x20
69 Console cover
70 Spring
71 Belt 240J4
72 Belt 230J3
73L Front Stabilizer Left End Cap
73R Front Stabilizer Right End Cap
74 Spring Washer Ø6.2
75 Screw M5x10
76 Hexagon Socket Bolt M8x43L
77 Handlebar End Cap Ø25.4
78 Front Frame Support Tube End Cap Ø22.2
79 Hand Pulse Sensor Wire
80 Nut M6
81 Screw M6x15
82 Hand Pulse Sensor
83 Countersunk Phillips Head Cap Screw M4x20
84 Nylon Nut 9/16 UNC12(L)
85 NOT labeled correctly, not nut cap
86 Nylon Nut 9/16 UNC12(R)
87 Left Pedal Strap
88 Right Pedal Strap
89 Crank Cover
9A Hand Pulse Sensor
9B Computer Wire
 

"YOUR ORDER WILL BE PROCESSED WITHIN 3 BUSINESS DAYS"

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