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Replacement Parts Order Form
Complete the form below. Your model number with color code and manufacturer date code MUST be included on the form to
ensure proper replacement parts. Your model number with color code and the date code can be found on a sticker on the
stroller frame. Payment in U.S. dollars must accompany your order. Choose parts needed from the list below. You can cross
reference your parts with the illustration on pages 2 and 3.
Return the form with payment to:
Dorel Juvenile Group, Inc.
Consumer Relations Department
P.O. Box 2609
Columbus, IN 47202-2609
Fax orders to: 1-800-207-8182
Replacement Parts List
Part Quantity . . . . . . . . . . . . . . . .Cost . . Quantity Ordered . . . . . . . . . . . .Total Cost
2 Single Wheels with Caps . . . . . . . .$5.99 . . . . . . . X ________ . . . . . . . . .= $__________
2 Dual Wheels . . . . . . . . . . . . . . . . .$4.50 . . . . . . . X ________ . . . . . . . . .= $__________
Hardware Bag
(Axle, Cotter Pins) . . . . . . . . . . . . .$5.00 . . . . . . . X ________ . . . . . . . . .= $__________
(Cotter Pins, Washers) . . . . . . . . .$2.00 . . . . . . . X ________ . . . . . . . . .= $__________
Front Child Tray . . . . . . . . . . . . . . . .$5.99 . . . . . . . X ________ . . . . . . . . .= $__________
Rear Child Tray . . . . . . . . . . . . . . . . .$5.99 . . . . . . . X ________ . . . . . . . . .= $__________
Parent Tray . . . . . . . . . . . . . . . . . . .$5.99 . . . . . . . X ________ . . . . . . . . .= $__________
Front Seat Pad . . . . . . . . . . . . . . . .$16.99 . . . . . . . X ________ . . . . . . . . .= $__________
Rear Seat Pad . . . . . . . . . . . . . . . .$16.99 . . . . . . . X ________ . . . . . . . . .= $__________
Front Canopy . . . . . . . . . . . . . . . . .$10.99 . . . . . . . X ________ . . . . . . . . .= $__________
Rear Canopy . . . . . . . . . . . . . . . . .$11.99 . . . . . . . X ________ . . . . . . . . .= $__________
Front Car Seat Mounting Bar . . . . . .$5.00 . . . . . . . X ________ . . . . . . . . .= $__________
Rear Car Seat Mounting Bar . . . . . .$5.00 . . . . . . . X ________ . . . . . . . . .= $__________
Instructions . . . . . . . . . . . . . . . . . . .$0.00 . . . . . . . X ________ . . . . . . . . .= $__________
(Indiana, Georgia, California, Arkansas, and
Massachusetts residents add applicable sales tax)
(Up to $25.00 . . . . . . . .$5.95
$25.01 to $50.00 . . . . . .$6.95
$50.01 to $75.00 . . . . . .$8.95
$75.01 to $100.00 . . . . .$9.95
$100.01 to $150.00 . . .$10.95
$150.01 to $200.00 . . .$11.95
$200.01 and up . . . . .$13.95)
10.00
We MUST have this
information to
process your order:
Model Number
(5 digits & 3 let-
ters)
Manufacture Date
(4 digit number)
Please make money orders payable to Dorel Juvenile Group, Inc. Fill in the
area below to charge to Visa or Mastercard. We do not except personal checks
or Discover Card. All outside of U.S. and Canada MUST use credit card.
NOTE: If requested color is not available, simular color will be substituted.
Fill Out For Credit Card Use
Visa Mastercard Card Exp. Date:
Cardholder’s Name:
Card Number:
Signature
Ship To:
Name:
Address:
City:
State/Province:
Telephone: ( ) Email Address:
No shipping and handling on instructions for quantities under 6.
Add $.50 for each instruction over 6, then add applicable shipping and handling.
(circle one)
12