Wachsmuth & Krogmann QL-3100B - Manual (Page 25)

ORDER FORM
FOR REPLACEMENT GUN LANCE, PRESSURE HOSE, SPRAY NOZZLE,
AND TURBO NOZZLE
Price per Gun Lance (includes shipping and handling $ 17.00)
Price per Pressure Hose (includes shipping and handling $ 14.00)
Price per Spray Nozzle (includes shipping and handling $ 10.00)
Price per Turbo Nozzle (includes shipping and handling $ 10.00)
Please send a MONEY ORDER only (no cash or personal checks) ,
payable to Wachsmuth & Krogmann Inc. to the following address:
Wachsmuth & Krogmann Inc,
123 Sivert Court
Bensenville, IL 60106
Kindly fill in your information below and send together with your
Money Order
Name
Street
City
State
ZIP
Date
Quantity of Item Gun Lance @ $
Quantity of Item Pressure Hose @ $
Quantity of Item Spray Nozzle @ $
Quantity of Item Turbo Nozzle @ $
Total amount $
24