Model No.
(Both Numbers Required)
SHIP TO:
Name
Address
City, State, Zip Code
Telephone (including Area Code)
Seat pad
Canopy
Canopy bow
Harness
Harness clip
Locking clip
Head support
Base
Serial No.
Check or money order enclosed
(payable to Graco Children's Products Inc.)
Charge to credit card
Visa
Account #
Expiration date
Signature
33
Subtotal:
Shipping
& handling*:
Sales tax**:
Total:
* $15.00 outside the
continental U.S.
**CA 6%, IL 6.25%, IN 5%, NY 8.25%,
OH 5.75%, PA 6%, SC 5%
MasterCard
$5.00
Discover