ENGLISH
A.
Front Wheel Assembly
$
B.
Rear Wheel Kit
$
C. Hub Cap Set
$
D. Seat Pad
$
E.
Comfort Pad
$
F. Canopy Pad
$
G. Canopy Frame
$
H. Car Seat Adapter with Brackets
$
I. Mesh Basket $
J. Napper Bar
$
K. Instructions & Parts Form
F R E E
Subtotal Amount $
Shipping & Handling (see chart page 7) $
Outside USA (see add-on chart page 7) $
Total Amount of Order $
SHIP TO:
Customer Name:
Street Address:
City, State, Zip:
Area Code:
Telephone Number:
8
REPLACEMENT PARTS ORDER FORM
Charge to credit card Visa
MasterCard
Card Number:
Expiration Date:
Cardholder’s Name:
Check Enclosed
Please make checks payable in U.S. currency to:
Century Products Company
**IMPORTANT**
We must have this information to process your
order. See label on right rear leg of stroller.
Model Number:
Manufacturer Date:
Please fill out and return this form to address shown on back of page.
PM-0624AB 3/98
