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2. First Name*
3. Last Name*
5. Address*
6. City*
8. Phone Number*
9. Number of Children*
10. Ages of Children*
12. We will contact you by phone to confirm an appointment time and date. Please note that it can take 30 minutes to 1 hour for each car seat to be installed properly. Please bring your vehicle manual and car seat manual with you to your appointment.
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14. 1. Receive an email copy of this form.
15. Email address

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16. Submit

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