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Model No. Serial No.
(Both numbers required)
SHIP TO:
Name
Address
City, State, Zip
( )
Telephone
Charge to credit card:
Visa
MasterCard
Discover
Account #:
Expiration date:
Signature:
Seat pad
Canopy
Canopy bow
3-point harness
5-point harness
Harness clip
Locking clip
Head support
Adjustable base
Subtotal:
Shipping
& handling*: $5.00
6% sales tax
(PA only):
Total:
*$15.00 outside the continental U.S.
Return the form above with payment to:
GRACO CHILDREN’S PRODUCTS INC.
CUSTOMER SERVICE DEPARTMENT
P.O. BOX 100, MAIN STREET, ELVERSON, PA 19520-9974
Check enclosed (payable to Graco Children’s Products Inc.)