Eddie Bauer 22-750 manual Fax orders to

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 47202-2609

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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