Wachsmuth & Krogmann QL-3100B For Replacement Gun Lance, Pressure Hose, Spray Nozzle, Money Order

Models: QL-3100B

1 25
Download 25 pages 6.89 Kb
Page 25
Image 25
ORDER FORM

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

Page 25
Image 25
Wachsmuth & Krogmann QL-3100B For Replacement Gun Lance, Pressure Hose, Spray Nozzle, And Turbo Nozzle, Money Order, Name