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ENGLISH
A. Front Wheel Assembly $
B. Rear Wheel Kit $
C. Hub Cap Set $
D. Seat Pad $
E. Comfort Pad $
F. Canopy Pad $
G. Canopy Frame $
H. Car Seat Adapter with Brackets $
I. Mesh Basket $
J. Napper Bar $
K. Instructions & Parts Form F R E E
Subtotal Amount $
Shipping & Handling (see chart page 7) $
Outside USA (see add-on chart page 7) $
Total Amount of Order $
SHIP TO:
Customer Name:
Street Address:
City, State, Zip:
Area Code: Telephone Number:
8
REPLACEMENT PARTS ORDER FORM
Charge to credit card Visa MasterCard
Card Number:
Expiration Date:
Cardholder’s Name:
Check Enclosed
Please make checks payable in U.S. currency to:
Century Products Company
**IMPORTANT**
We must have this information to process your
order. See label on right rear leg of stroller.
Model Number:
Manufacturer Date:
Please fill out and return this form to address shown on back of page.
PM-0624AB 3/98