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 US 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 bottom tubing of Playard/Crib.
Model No.:
Manufacture Date:
NOTE:
If requested color is not available, a similar color
will be substituted.
PM-1717AA 9/00
Shipping & Handling
US $ 0.01 to $ 9.99
=
US $ 3.00
(CAN $ 0.01 to $ 15.49
= CAN $ 4.75)
US $ 10.00 and over
=
US $ 5.00
(CAN $ 15.50 and over
= CAN $ 7.75)
Outside Continental USA
Add: US $ 10.00
(CAN $ 15.50)
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
