Century PM-1647AA Replacement Parts Order Form, Century Products P.O. Box Elverson, Pa, Ship To

REPLACEMENT PARTS ORDER FORM

Total Parts	$
Sales Tax	$
Shipping & Handling	$
Outside Continental USA	$
Total	$

We must have this information to process your order: see label on bottom tubing of Playard.

Model No.:

Manufacture Date:

Sales Tax

•California, Illinois, Indiana, Maryland and New York Residents Add Sales & Applicable Local Taxes

•Ohio Residents Add 5.75% Sales Tax

•Pennsylvania Residents Add 6% Sales Tax except for Philadelphia and Allegheny Counties add 7% Sales Tax

•South Carolina Residents Add 5% Sales Tax

Shipping & Handling
	US $	0.01 to $	9.99	=	US $ 3.00
(CAN $		0.01 to $	15.49	=	CAN $ 4.75)
	US $ 10.00 and over			=	US $ 5.00
(CAN $ 15.50 and over				=	CAN $ 7.75)
Outside Continental USA
Add:	US $ 10.00
	(CAN $ 15.50)

Please make checks payable to CENTURY PRODUCTS or charge to VISA, MASTERCARD or DISCOVER.

Orders outside USA Must use credit card.

Cardholder’s Name:

Card Number:

Card Exp. Date:

Check enclosed for $

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

SHIP TO:

Name:

Address:

City:

State:Zip:

Telephone No.:( )

MAIL BOTH PAGES OF ORDER TO:

CENTURY PRODUCTS

P.O. BOX 100

ELVERSON, PA 19520-9974

ATTENTION: CUSTOMER SERVICE DEPARTMENT

FAX BOTH PAGES OF ORDER TO:

(610) 286-4555 PM-1647AA 6/00