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Replacement Parts List
NOTE: If requested color is not available, similar color will be
substituted. Prices are subject to change.
Part Cost Quantity Total Cost
Buckle Strap/Buckle .... $4.99 X _____ = $ ______________
Harness Strap ............. $2.00 X _____ = $ ______________
Pad Set .................... $35.99 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
q Visa q 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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