Dorel 01-068 Replacement Parts Order Form, Replacement Parts List, Fill Out For Credit Card Use

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 stroller frame. Payment in U.S. dollars must accompany your order. Choose parts needed from the list below. You can cross reference your parts with the illustration on pages 2 and 3.

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 except personal checks or Discover Card. All outside of U.S. and Canada MUST use credit card.

NOTE: If requested color is not available, simular color will be substituted.

We MUST have this

information to

process your order:

Model Number

(5 digits & 3 let-

ters)

Manufacture Date (4 digit number)

Replacement Parts List

Part Quantity	. .Cost . .	Quantity Ordered		. . . . . .	.Total Cost
2 Single Wheels with Caps	. .$5.99 . .	. . . . . X	________	. . .= $__________
2 Dual Wheels	. .$4.50 . .	. . . . . X	________	. . .= $__________
Hardware Bag
(Axle, Cotter Pins)	. .$5.00 . .	. . . . . X	________	. . .= $__________
(Cotter Pins, Washers)	. .$2.00 . .	. . . . . X	________	. . .= $__________
Front Child Tray	. .$5.99 . .	. . . . . X	________	. . .= $__________
Rear Child Tray	. .$5.99 . .	. . . . . X	________	. . .= $__________
Parent Tray	. .$5.99 . .	. . . . . X	________	. . .= $__________
Front Seat Pad	.$16.99 . .	. . . . . X	________	. . .= $__________
Rear Seat Pad	.$16.99 . .	. . . . . X	________	. . .= $__________
Front Canopy	.$10.99 . .	. . . . . X	________	. . .= $__________
Rear Canopy	.$11.99 . .	. . . . . X	________	. . .= $__________
Front Car Seat Mounting Bar . . . .	. .$5.00 . .	. . . . . X	________	. . .= $__________
Rear Car Seat Mounting Bar . . . .	. .$5.00 . .	. . . . . X	________	. . .= $__________
Instructions	. .$0.00 . .	. . . . . X	________	. . .= $__________
No shipping and handling on instructions for quantities under 6.				Total $
Add $.50 for each instruction over 6, then add applicable shipping and handling.

12

Fill Out For Credit Card Use

Visa Mastercard Card Exp. Date:

(circle one)

Cardholder’s Name:

Card Number:

Signature

Ship To:

Name:

Address:

City:

State/Province:

Telephone: ( ) Email Address:

Sales Tax $

(Indiana, Georgia, California, Arkansas, and Massachusetts residents add applicable sales tax)

Add Shipping and Handling

(Up to $25.00 . . . . . . . .$5.95 $25.01 to $50.00 . . . . . .$6.95 $50.01 to $75.00 . . . . . .$8.95 $75.01 to $100.00 . . . . .$9.95 $100.01 to $150.00 . . .$10.95 $150.01 to $200.00 . . .$11.95 $200.01 and up . . . . .$13.95)

$

Outside Continental USA $ 10.00

Grand Total $