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