Replacement parts order form, Ship to – Century LIFESTYLE SERIER PM-1722AC User Manual

Page 14

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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

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