Wachsmuth & Krogmann XQ-698T - Manual (Page 10)

ORDER FORM
FOR REPLACEMENT PERMANENT COFFEE FILTER
Price per filter (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 filters filter @ $
Total amount $
10