Combi DK-5 4050 instruction manual Parts Order Form

PartsOrder Form

DK-54050 Series

Instruction Manual

If you would like to place an order for the following parts, please fill out the form below and return to the following address:

Combi USA, Inc.	or Fax this completed form to
Attn: Consumer Affairs Department	803-548-3663
1962 Highway 160 W, Suite 100
Fort Mill, SC 29708-8027

IMPORTANT: We must have this information to process your order:

Model Number: 4050 - ______ Color & Pattern of Fabric: ______________________________________________________

Located on the rear right leg.

Parts List for the DK-5 (4050 Series) only.

				Price	Quantity	Total
1.	Seat Cushion		40.00
2.	Basket		25.00
3.	Canopy		45.00
4.	Stroller Pack		25.00
5.	Egg Shock Pad		40.00
6.	Shoulder Pad/Set		15.00
7.	Shoulder Strap		20.00
8.
9.
10.
11.
If you need to order other parts for your stroller, please call us toll-free at Amount of Order
1-800-992-6624.
				ADD
Shipping and Handling Fees: Add $8.00 for orders $34.99 and under. Add
				Shipping & Handling
$13.00 for orders $35.00 and over. Note: Additional shipping charges will apply
outside of the Continental U.S. Combi USA reserves the right to change pricing at				Sales Tax (6%)
any time.
				(SC residents only)
Ship To:				Total
			Charge to my credit card:
				 VISA	 MASTERCARD
Customer Name
				 AMERICAN EXPRESS	 DISCOVER
Street Address
		Card Number
Street Address		Expiration Date __________ - ___________ - ____________
City, State, Zip
		Cardholder’s Signature
		 Check enclosed
Telephone Number						120304

Combi USA, Inc. • 1962 HWY 160 W, Suite 100 • Fort Mill, SC 29708 • www.combi-intl.com

Consumer Affairs 1-800-992-6624