Replacement Parts Order Form; Replacement Parts List - Dorel Juvenile Group Scenera Instructions Manual

4358-5405 Can Scenera 12/8/10

Replacement Parts Order Form

For replacement parts, complete this form below. We must have
your model number and manufacture date codes on the form to
ensure proper replacement parts. They can be found on the stickers
on the side of the restraint system shell. Payment in U.S. dollars
must accompany your order. Choose parts needed from the list
supplied.
Mail form and payment to;
Dorel Juvenile Group. Inc.
2525 State Street
Columbus, IN 47201-7494
Fax to: 1-800-207-8182
Website: www.djgusa.com
Please make money order payable to Dorel Juvenile Group, Inc. See
next page for Visa or MasterCard payment. We do not accept
personal checks or Discover Card. For orders outside of Canada and
the U.S. we accept Visa or MasterCard only.
We MUST have this information to process your order:
Model Number (5 digits & 4 letters): ____________________
Manufacture Date (yyyy/mm/dd): ______________________
Ship to (please print)________________________________
Name____________________________________________
Address __________________________________________
City______________________________________________
Province _____________________________________
Postal code_______________ Country _____________
Telephone (area code)_______________________________
E-mail address______________________________________
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Replacement Parts List

NOTE: If requested color is not available, similar color will be
substituted.
Part Cost Quantity Total Cost
Buckle/Crotch Strap . .$6.99 X ______= $ ______________
Harness Strap . . . . . . .$2.99 X ______= $ ______________
Seat Pad . . . . . . . . .$29.99 X ______= $ ______________
Chest Clip . . . . . . . . . .$1.50 X ______= $ ______________
Locking Clip . . . . . . . .$2.50 X ______= $ ______________
UAS Kit . . . . . . . . . . .$24.99 X ______= $ ______________
Instructions . . . . . . . . .$0.00 X ______= $ ______________
Merchandise Total
Shipping and handling:
$100.01 to $150.00 . . . . . .$10.95
Up to $25.00 . . . . . . . . . . . .$5.95
$150.01 to $200.00 . . . . . .$11.95
$25.01 to $50.00 . . . . . . . .$6.95
$200.01 and up . . . . . . . . .$13.95
$50.01 to $75.00 . . . . . . . .$8.95
Outside Continental USA $10.00
$75.01 to $100.00 . . . . . . .$9.95
Sales Tax
Residents of Quebec, add 5% GST and 7.5% QST.
Residents of New Brunswick, Newfoundland, Ontario and Nova Scotia, add
13% HST.
Residents of British Columbia add 12% HST.
All other provinces, add 5% GST.
Grand Total
No shipping and handling on instructions for quantities under 6. Add $.50 for each
instruction over 6, then add applicable shipping and handling.
Fill Out For Credit Card
Visa Mastercard
Card Exp. Date: ________________________________
Cardholder's Name: ____________________________
Card Number: ________________________________
Signature ____________________________________
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$ ________________
$ ________________
$ ________________
$ ________________