Child Safety Seat
Child Safety Seats Save Lives
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High Back Booster Seat Product # 22-491FSM
• Rear Facing 5-40 lbs. • Forward Facing 22-40 lbs. • 4 harness heights • 3 buckle locations •Side Impact Protection •5 point harness •Up front harness adjustment •Removable fabric pad • 2 integrated cup holders • Forward Facing Only. 30-100 lbs. • Removable fabric pad • Must use vehicle lap and shoulder belt • Back removes for backless booster 40-100 lbs. • Easily converts to a backless booster for children 40-100 lbs. • Adjustable height positions • Slide out cup holder
Pattern/Color is factory selected Pattern/Color is factory selected State:____
*Limit (3) Car Seats and (3) Booster Seats per membership
_______
22-491FSM High Back Booster Seat $15
Quanity _______
Member Price $25
Description CC047FSM Convertible Car Seat
Model
Total .Cost
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______
(No PO Boxes accepted - Must use physical street address)
** In order to serve you better, you must have your Farm Bureau member number ready when calling.**
For questions regarding your order, call Child Source Customer Service Department at 800-815-6330, ext. 118.
Please allow up to three (3) weeks for delivery.
Child Source 305 Lake Road Medina, OH 44256
Please make checks payable to: CHILD SOURCE CREDIT CARDS NOT ACCEPTED Send your check/money order & order form to:
Company Name:_______________________________
City:_________________________ State: ____ Zip:___________
Address:____________________________________________
Name:_____________________________________________
Daytime Phone #:___________________________________
(Required to process order)
Farm Bureau Member #:__________________
Please print clearly and legibly. You MUST complete all lines to process order.
Fax and Phone orders not accepted.
Arkansas Farm Bureau Federation Child-Saver Program Order Form
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Convertible Car Seat Product # CC047FSM