Model No.

Serial No.

(Both Numbers Required)

SHIP TO:

Name

Address

City, State, Zip Code

Telephone (including Area Code)

Subtotal:

Shipping

 

& handling*:

$5.00

Sales tax**:

Total:

*$15.00 outside the continental U.S.

**CA 7.25%, IL 6.25%, IN 5%,

NY 8.25%, OH 5.75%, PA 6%, SC 5%

Seat pad

Check or money order enclosed

Canopy

(payable to Graco Children’s Products Inc.)

Canopy bow

Charge to credit card

3-point harness

Visa

MasterCard

Discover

5-point harness

 

Harness clip

 

Account #

Locking clip

 

Head support

 

Expiration date

Base

 

LATCH

 

Signature

 

Return the form with payment to:

Graco Children’s Products Inc.

Customer Service Department

P.O. Box 100, Main Street

Elverson, PA 19520

43

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Graco 6212, 6213 manual Ship to