Exerpeutic 1111 Owner's Manual Page 23

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PARADIGM
PARTS REQUEST FAX FORM
Please fax this form to (1-626-810-2166)
OR YOU CAN EMAIL CUSTOMER SERVICE REQUESTS TO
NAME: _________________________________________________________________
ADDRESS: ______________________________________________________________
CITY ______________ STATE ______________ ZIP ___________________
TELEPHONE: (Day) _______________________________________________________
(Night) ______________________________________________________
(Email Address) ______________________________________________
SERIAL#: ___________________________________________________
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