Century PM-0624AB SHIP TO:, ENGLISH, **IMPORTANT, REPLACEMENT PARTS ORDER FORM

ENGLISH

REPLACEMENT PARTS ORDER FORM

Please fill out and return this form to address shown on back of page.

A. Front Wheel Assembly

$

**IMPORTANT**

B. Rear Wheel Kit

$

We must have this information to process your

C. Hub Cap Set

$

order. See label on right rear leg of stroller.

Model Number:

D. Seat Pad

$

Manufacturer Date:

E. Comfort Pad

$

F. Canopy Pad

$

Charge to credit card Visa

MasterCard

G. Canopy Frame

$

Card Number:

Expiration Date:

H. Car Seat Adapter with Brackets

$

Cardholder’s Name:

I.

Mesh Basket

$

Check Enclosed

Please make checks payable in U.S. currency to:

J.

Napper Bar

$

Century Products Company

K. Instructions & Parts Form

F R E E

SHIP TO:

Subtotal Amount $

Customer Name:

Shipping & Handling (see chart page 7)

$

Outside USA (see add-on chart page 7)

$

Street Address:

Total Amount of Order $

City, State, Zip:

Area Code:

Telephone Number:

PM-0624AB 3/98

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