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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 U.S. 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 leg of stroller.
Model No.:
Manufacture Date:
NOTE: If requested color is not available, a similar color
will be substituted.
PM-1722AC 2/01
Shipping & Handling
$ 0.01 to $ 9.99 = $ 3.00
$ 10.00 and over = $ 5.00
Outside Continental USA
Add $10.00
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