N° de modelo
(Se requieren nú mero)
Left arm pad /Almohadilla del brazo izquierdo
Right arm pad /Almohadilla del brazo derecho
Head and lower back support/
Apoyacabezas y respaldo
Back support pad /Almohadilla del respaldo
Head support pad /Almohadilla del apoyacabezas
Base pad /Almohadilla de la base
Base assembly (without pad) /
Montaje de la base (sin almohadilla)
Shoulder belt positioning clip /
Clip de colocació n del cinturó n de hombro
Instruction booklet / Manual de instrucciones
Total: |
|
|
| Check or money order enclosed | |||
Gastos de envío*: | $5.00 |
| (payable to Graco Children’s | ||||
Impuestos**: |
|
|
| Products Inc.) |
| ||
|
|
| Cheque o giro adjunto (a nombre | ||||
Total a pagar: |
|
|
| ||||
|
|
| de Graco Children's Products Inc.) | ||||
*$15.00 outside the continental |
|
|
| ||||
|
|
|
|
|
| ||
U.S.*US$ 15,00 para fuera del |
|
|
| Charge to credit card |
| ||
continente de EE.UU |
|
|
| Cargar a la tarjeta de crédito | |||
**CA 7.25%, IL 6.25%, IN 5%, |
|
|
| ||||
|
|
|
|
|
| ||
NY 8.25%, OH 5.75%, PA 6%, |
|
|
| Visa | MasterCard | Discover | |
SC 5% |
|
|
| ||||
|
|
|
|
|
| ||
| Ship to • Enviar a : |
|
|
|
|
| |
|
|
| Account #: • Cuenta N° |
| |||
| Name • Nombre: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| Exp. date • Fecha de vencimiento | ||
| Address • Dirección: |
|
|
| |||
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
| Signature • Firma |
| |
| City, State, Zip • Ciudad, Estado, |
|
|
|
| ||
| Codigo postal: |
|
|
|
|
|
|
|
|
|
| ||||
|
|
|
| ||||
| Telephone • Telefono: |
|
| ||||
|
|
|
| _______________________________ | |||
37
