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Cardholder’s Name:
Card Number:
Card Exp. Date:
Check enclosed for $
SHIP TO:
Name:
Address:
City:
State: Zip:
Telephone No.:( )
Please make checks payable in U.S. Currency to:
CENTURY PRODUCTS
Or charge to VISA or MASTERCARD :
Total Parts $
Sales Tax $
Shipping & Handling $
Outside Continental USA $
Total $
MAIL BOTH PAGES OF ORDER TO:
CENTURY PRODUCTS
P.O. BOX 100
ELVERSON, PA. 19520-9974
ATTENTION: CUSTOMER SERVICE DEPARTMENT
FAX BOTH PAGES OF ORDER TO:
(610) 286-4555
Shipping & Handling
$ 0.01 to $ 5.00 = $ 4.00
$ 5.01 to $ 50.00 = $ 5.00
$ 50.01 to $200.00 = 10% of Order Total
$200.01 and over = 5% of Order Total
Outside Continental USA
$ 2.00 = AK, HI, PR, VI, Guam
$10.00 = Mexico
All others, call for quote.
Sales Tax
• California, Indiana, Maryland and
New York Residents Add Sales &
Applicable Local Taxes
• Ohio Residents Add 5.75% Sales Tax
• Pennsylvania Residents Add 6% Sales
Tax except for Philadelphia and
Allegheny Counties add 7% Sales Tax
• South Carolina Residents Add 5% Sales
Tax
REPLACEMENT PARTS ORDER FORM
We must have this information to process your order: see label
on leg of stroller.
Model No.:
Manufacture Date:
NOTE: If requested color is not available, a similar color
will be substituted.
PM-1304AA 6/99