Combi Select DK-5 4050 Series Gebrauchsanweisung - Seite 14

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Parts Order Form

If you would like to place an order for the following parts, please fill out the form below and return
to the following address:
Combi USA, Inc.
Attn: Consumer Affairs Department
1962 Highway 160 W, Suite 100
Fort Mill, SC 29708-8027
We must have this information to process your order:
IMPORTANT:
Model Number: 4050 - ______ Color & Pattern of Fabric: ______________________________________________________
Located on the rear right leg.
Parts List for the DK-5 (4050 Series) only.
1. Seat Cushion
2. Basket
3. Canopy
4. Stroller Pack
5. Egg Shock Pad
6. Shoulder Pad/Set
7. Shoulder Strap
8.
9.
10.
11.
If you need to order other parts for your stroller, please call us toll-free at
1-800-992-6624.
Shipping and Handling Fees: Add $8.00 for orders $34.99 and under. Add
$13.00 for orders $35.00 and over. Note: Additional shipping charges will apply
outside of the Continental U.S. Combi USA reserves the right to change pricing at
any time.
Ship To:
Customer Name
Street Address
Street Address
City, State, Zip
Telephone Number
Combi USA, Inc. • 1962 HWY 160 W, Suite 100 • Fort Mill, SC
or
Fax this completed form to
803-548-3663
Consumer Affairs 1-800-992-6624
DK-5
4050 Series
Instruction Manual
Price
40.00
25.00
45.00
25.00
40.00
15.00
20.00
Amount of Order
ADD
Shipping & Handling
Sales Tax (6%)
(SC residents only)
Total
Charge to my credit card:
VISA
AMERICAN EXPRESS
Card Number
Expiration Date __________ - ___________ - ____________
Cardholder's Signature
Check enclosed
29708 • www.combi-intl.com
Quantity
Total
MASTERCARD
DISCOVER
120304