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* required fields
 

Distributor Name
 
Branch
 

 
Sales Person
 
Cell Phone #
 
Contractor
 
Cell Phone
 

 
Home Owner*
 
Home Phone*
 
Work Phone
 
E-mail Address
 
Best time to contact *
 

 
Mailing Address*
 
Town*
 
State* Please Select: AL AK AZ AR CA CO CT DE D.C. FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
 
Zip*
 

 
Physical Address*
 
Town*
 
State Please Select: AL AK AZ AR CA CO CT DE D.C. FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
 
Zip*
 

 
Directions to Job*

 
Location of Unit* Please Select: 1st Floor 2nd Floor Foyer
 
Is Staging Necessary? * Please Select: Yes No
 

 
Distributor PO #
 
Paradigm Winsys #
 
Where do I find the Winsys number?
 
Date Purchased
 
Date Installed
 

 
Describe Problem With Paradigm Unit *

 
Affected Sash* Please Select Top Bottom Left Right Center Operator Stationary
 
Additional Comments For This Service Request

 

If unable to locate the warranty label on the unit fill out below
 
Type of Window
 
Style of Window
 
Color
 
Grids
 
Glass
 
Screen
 
Exact TTT
Sash Size
 
Exact TTT
Glass Size
 
 

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