Replacement Parts Order Form - DJG Alpha Omega Instruction Manual

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Replacement Parts Order Form

Complete the form below. Your model number with color

code and manufacturer date code MUST be included on

the form to ensure proper replacement parts. Your model

number with color code and the date code can be found on a

sticker on the side of child restraint. Payment in U.S. dollars

must accompany your order. Choose parts needed from the

list on next page.

Return the form with payment to:

Dorel Juvenile Group, Inc.

Consumer Relations Department

P.O. Box 2609

Columbus, IN 47202-2609

Fax orders to: 1-800-207-8182

Please make money orders payable to Dorel Juvenile

Group, Inc. Fill in the area below to charge to Visa or

Mastercard. We do not accept personal checks or Discover

Card. All outside of U.S. and Canada MUST use credit card.

Ship To (Please Print): ___________________________

Name: _______________________________________

Address: _____________________________________

City: ________________________________________

State/Province: ___________________ Zip: __________

Telephone: ___________________________________

Email Address: _________________________________

MUST

have this information to process your order:

Model Number (5 digits & 3 letters): _____________

Manufacture Date (mm/dd/yyyy): ________________

1/26/12 11:06 AM

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