Graco 6110, 6111, 6114, 6113 manual Ship to

Model No. Serial No.

(Both Numbers Required)

SHIP TO:

Name

Address

City, State, Zip Code

Telephone (including Area Code)

Subtotal:

Shipping	$5.00
& 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%

Seat pad	Check or money order enclosed
Canopy	(payable to Graco Children’s Products Inc.)
Canopy bow	Charge to credit card
3-point harness	Visa	MasterCard	Discover
5-point harness
Harness clip
	Account #
Locking clip

Head support
	Expiration date
Base
	Signature

Return the form with payment to:

Graco Children’s Products Inc.

Customer Service Department

P.O. Box 100, Main Street

Elverson, PA 19520

41