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Model No.
Serial No.
(Both numbers required)
SHIP TO:
Name
Address
City, State, Zip
( )
Telephone
Check or money order enclosed
(payable to Graco Children’s Products Inc.)
Charge to credit card:
Visa MasterCard Discover
Locking clip
Harness with buckles
and harness clip
Seat cover
Crotch strap w/buckle
Tether strap
2-Piece Chest Clip
Cupholder
Subtotal:
Shipping
& handling*: $5.00
Sales tax**:
Total:
* $15.00 outside the continental U.S.
**CA 6%, IL6.25%, IN 5%, NY
8.25%, OH 5.75%, PA 6%, SC 5%
Account #:
Expiration date:
Signature: