DJG Highrise Instruction Manual - Page 13

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4358-3341C High Rise

12/1/05

Replacement Parts Order Form

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 underneath the child

restraint. Payment in U.S. dollars must accompany your

order. Choose parts needed from the list on the back

page of the manual.

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.

2:05 PM

Page 25

Ship To (Please Print): ____________________________

Name: ________________________________________

Address: ______________________________________

City: __________________________________________

State/Province: ________________________Zip ______

Telephone: ____________________________________

Email Address: __________________________________

MUST

have this information to process your

order:

Model Number (5 digits & 3 letters): __________

Manufacture Date (mm/dd/yyyy): ______________