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. or Fax this completed form to
Attn: Consumer Affairs Department
1962 Highway 160 W, Suite 100
Fort Mill, SC 29708-8027
IMPORTANT: We must have this information to process your order:
Model Number: 4050 - ______ Color & Pattern of Fabric: ______________________________________________________
Parts List for the DK-5 (4050 Series) only.
Price Quantity Total
1. Seat Cushion 40.00
2. Basket 25.00
3. Canopy 45.00
4. Stroller Pack 25.00
5. Egg Shock Pad 40.00
6. Shoulder Pad/Set 15.00
7. Shoulder Strap 20.00
8.
9.
10.
11.
Amount of Order
ADD
Shipping & Handling
Sales Tax (6%)
(SC residents only)
Total
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
120304
803-548-3663
Located on the rear right leg.
DK-5
4050 Series
Instruction Manual
Charge to my credit card:
VISA MASTERCARD
AMERICAN EXPRESS DISCOVER
Card Number
Expiration Date __________ - ___________ - ____________
Cardholder’s Signature
Check enclosed
Combi USA, Inc. • 1962 HWY 160 W, Suite 100 • Fort Mill, SC 29708 • www.combi-intl.com
Consumer Affairs 1-800-992-6624
