ITM 5500 Form

ITM 5500 Form | Health Gear Deluxe Inversion Table

Name *

First

Last

Email Address *

Phone *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Model *

Production Code (PC) *

Found on the front cover of the owners manual- the upper right corner. It starts PC-...

Part Number *

Find the correct part number in your Onwer's Manual

Quantitiy

# of pieces you need for the part. See the quantity after each part number (x_)

Part Number (additional) *

If you need more than one part.

Quantitiy

How many pieces of this part do you need?

Store Purchased From *

Where did you purchase this inversion table from?

Date Purchased

Date (or approx. date) purchased