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Replacement Parts List
NOTE:
If requested color is not available, similar color will be
substituted.
Part
Cost
Quantity Total Cost
Buckle Strap/Buckle . .$4.99 X ______= $ ______________
Harness Strap . . . . . . .$2.00 X ______= $ ______________
Pad Set . . . . . . . . . .$42.00 X ______= $ ______________
Chest Clip . . . . . . . . . .$1.50 X ______= $ ______________
Locking Clip . . . . . . . .$2.50 X ______= $ ______________
Tether Kit . . . . . . . . . .$9.99 X ______= $ ______________
Latch Kit . . . . . . . . . .$24.99 X ______= $ ______________
Instructions . . . . . . . . .$0.00 X ______= $ ______________
Merchandise Total $ ________________
Shipping and handling:
$
Sales Tax $ ________________
(Indiana, California, and Massachusetts residents add applicable sales tax.
Grand Total $ ________________
No shipping and handling on instructions for quantities under 6. Add $.50 for each
instruction over 6, then add applicable shipping and handling.
Fill Out For Credit Card
K
Visa
K
Mastercard
Card Exp. Date: ________________________________
Cardholder’s Name: ____________________________
Card Number: ________________________________
Signature ____________________________________
Up to $25.00 . . . . . . . . . . . .$5.95
$25.01 to $50.00 . . . . . . . .$6.95
$50.01 to $75.00 . . . . . . . .$8.95
$75.01 to $100.00 . . . . . . .$9.95
$100.01 to $150.00 . . . . . .$10.95
$150.01 to $200.00 . . . . . .$11.95
$200.01 and up . . . . . . . . .$13.95
Outside Continental USA $10.00
CUT ON DOTTED LINE
Complete the form below. Your model number with color code and
manufacturer date code MUST be included on the form to ensure
proper replacement parts. Your model number with color code and
the date code can be found on a sticker on the side of child
restraint. Payment in U.S. dollars must accompany your order.
Choose parts needed from the list on the next page.
Return the form with payment to:
Dorel Juvenile Group, Inc.
Consumer Relations Department
P.O. Box 2609
Columbus, IN 47202-2609
Fax orders to: 1-800-207-8182
Please make money orders payable to Dorel Juvenile Group, Inc. Fill
in the area below to charge to Visa or Mastercard. We do not accept
personal checks or Discover Card. All outside of U.S. and Canada
MUST use credit card.
Ship To (Please Print): ________________________________
Name: ____________________________________________
Address: __________________________________________
City: ______________________________________________
State/Province: __________________________Zip ________
Telephone: ________________________________________
Email Address: ______________________________________
We
MUST
have this information
to process your order:
Model Number (5 digits & 3 letters): __________________
Manufacture Date (mm/dd/yyyy): ____________________
Replacement Parts Order Form
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