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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 US currency to CENTURY
PRODUCTS or charge to VISA, MASTERCARD or DISCOVER.
Orders outside USA Must use credit card.
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
or
FAX BOTH PAGES OF ORDER TO:
(610) 286-4555
REPLACEMENT PARTS ORDER FORM
We must have this information to process your order: see
label on bottom tubing of Playard/Crib.
Model No.:
Manufacture Date:
NOTE: If requested color is not available, a similar color
will be substituted.
PM-1779AA 10/00
Shipping & Handling
US $ 0.01 to $ 9.99 = US $ 3.00
(CAN $ 0.01 to $ 15.49 = CAN $ 4.75)
US $ 10.00 and over = US $ 5.00
(CAN $ 15.50 and over = CAN $ 7.75)
Outside Continental USA
Add: US $ 10.00
(CAN $ 15.50)
Sales Tax
• California, Illinois, 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