Graco 6111 Manual page 79

Model No.
(Both Numbers Required)
SHIP TO:
Name
Address
City, State, Zip Code
Telephone (including Area Code)
Seat pad
Canopy
Canopy bow
3-point harness
5-point harness
Harness clip
Locking clip
Head support
Base
LATCH
Check or money order enclosed
(payable to Graco Children's Products Inc.)
Charge to credit card
Account #
Expiration date
Signature
Return the form with payment to:
Graco Children's Products Inc.
Customer Service Department
P.O. Box 100, Main Street
Elverson, PA 19520
Serial No.
Subtotal:
Shipping
& handling*:
Sales tax**:
Total:
* $15.00 outside the
continental U.S.
**CA 7.25%, IL 6.25%, IN 5%,
NY 8.25%, OH 5.75%, PA 6%, SC 5%
Visa MasterCard
43
$5.00
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