Each Replacement Parts Order Form is only for ONE Product.
Please DO NOT submit multiple request for the same items in order to AVOID DELAYS in the process your request.

If you need parts from multiple products, please fill out a form for each individual Product as needed.

We will confirm that you have registered your product before we process your request for replacement parts.
First Name *
Last Name *
Address *
City *
State *
Abbreviate State: NY
Zip Code *
Phone Number *
Email Address *
Products Name
Product Model Number *
Where was this playcenter purchased? *
Date of Product Registration *
Product must be registered within 30 days of purchase. If this is has not been completed, please do so, by registering on our website and emailing a copy of the reciept to service@mid-america.biz with your name for proof of purchase.
Please create a LIST of parts needed including: part number, part name, quantity, reason for replacment (damaged or missing) Please press ENTER after each item to create a LIST format. *
Example: LR275 Saftey Slat (1) missing
Additional Comments (FROM CUSTOMER)
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