/CarSeatOrderForm

Child Safety Seat

速 www.arfb.com www.facebook.com/arkansasfarmbureau twitter.com/arfb www.youtube.com/arkansasfarmbureau

Convertible Car Seat 22-120FSM

• Rear Facing

5-35 lbs.

• Forward Facing

22-40 lbs.

• Five-point harness system

• Removable, padded fabric pad

• Up-front harness adjustment

Color is factory selected •F Forward d FFacing i O Only. l 30-100 30 100 lbs. lb • 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

Color is factory selected State:____

______

______

Total

.Cost

Child Source 5216 Portside Drive Medina, OH 44256

** 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. 18.

Please allow up to three (3) weeks for delivery.

*Limit (3) Car Seats and (3) Booster Seats per membership

_______

22-491FSM Cosco-High Back Booster Seat $15

Quanity _______

Member Price $25

Description 22-120FSM Cosco-Convertible Seat

Model

(No PO Boxes accepted - Must use physical street address)

City:_________________________ State: ____ Zip:___________

Address:____________________________________________

Name:_____________________________________________

Please make checks payable to: CHILD SOURCE CREDIT CARDS NOT ACCEPTED Send your check/money order & order form to:

Company 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

-- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --

High Back Booster Seat Product #: 22-491RDT Produt Name: Pronto