4358-3410D Alpha 5pt 1/26/06 11:39 AM Page 59
Complete the form below. Your model number with color code and manufacturer date code MUST be included on the form to ensure proper replacement parts. Your model number with color code and the date code can be found on a sticker on the side of child restraint. Payment in U.S. dollars must accompany your order. Choose parts needed from the list on next page.
Return the form with payment to:
Dorel Juvenile Group, Inc.
Consumer Relations Department
P.O. Box 2609
Columbus, IN
Fax orders to: 1-800-207-8182
Please make money orders payable to Dorel Juvenile Group, Inc. Fill in the area below to charge to Visa or Mastercard. We do not accept personal checks or Discover Card. All outside of U.S. and Canada MUST use credit card.
Ship To (Please Print): ________________________________
Name: ____________________________________________
Address: __________________________________________
City:______________________________________________
State/Province: ________________________Zip __________
Telephone: ________________________________________
Email Address: ______________________________________
We MUST have this information to process your order:
Model Number (5 digits & 3 letters): ______________
Manufacture Date (mm/dd/yyyy): ________________
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