Model No. |
| Serial No. |
| Account #: |
(Both numbers required)
Seat pad Canopy Canopy bow
Charge to credit card:
Visa
MasterCard
Discover
Expiration date:
Signature:
Locking clip Head support Adjustable base
Check enclosed (payable to Graco Children’s Products Inc.)
SHIP TO:
Subtotal:
Shipping
& handling*: $5.00
6% sales tax (PA only):
Total:
*$15.00 outside the continental U.S.
Name
Address
City, State, Zip
()
Telephone
Return the form above with payment to:
GRACO CHILDREN’S PRODUCTS INC.
CUSTOMER SERVICE DEPARTMENT
P.O. BOX 100, MAIN STREET, ELVERSON, PA
