Century Travel SolutionsTM Plus manual Replacement Parts Order Form, Ship To, on leg of stroller

	REPLACEMENT PARTS ORDER FORM
		Sales Tax
Total Parts	$	• California, Indiana, Maryland and
		New York Residents Add Sales &
		Applicable Local Taxes

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

•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
$	0.01 to $	5.00	= $	4.00
$	5.01 to $	50.00	= $	5.00
$	50.01 to $200.00		= 10% of Order Total
$200.01 and over			= 5% of Order Total

We must have this information to process your order: see label	Outside Continental USA
on leg of stroller.

Model No.:

Manufacture Date:

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

CENTURY PRODUCTS

Or charge to VISA or MASTERCARD :

Cardholder’s Name:

Card Number:

Card Exp. Date:

Check enclosed for $

$ 2.00 = AK, HI, PR, VI, Guam $10.00 = Mexico

All others, call for quote.

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-1028AB 5/99