Replacement Parts Order Form - Century 4 in 1System Pro Sport Plus Instruction Manual

REPLACEMENT PARTS ORDER FORM

A. Front Wheel Assembly
B. Rear Wheel Kit
C. Hub Cap Set
D. Seat Pad
E. Comfort Pad
F. Canopy Pad
G. Canopy Frame
H. Car Seat Adapter with Brackets
I. Mesh Basket
J. Napper Bar
K. Instructions & Parts Form
Shipping & Handling (see chart page 7) $
Outside USA (see add-on chart page 7) $
Total Amount of Order $
Please fill out and return this form to address shown on back of page.
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F R E E
Subtotal Amount $
**IMPORTANT**
We must have this information to process your
order. See label on right rear leg of stroller.
Model Number:
Manufacturer Date:
Charge to credit card
Card Number:
Expiration Date:
Cardholder's Name:
Check Enclosed
Please make checks payable in U.S. currency to:
Century Products Company
SHIP TO:
Customer Name:
Street Address:
City, State, Zip:
Area Code: Telephone Number:
Visa MasterCard
PM-0624AB 3/98 8