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Order card KH107
Quantity
ordered
Name of article Cost p. Unit Total sum
Set of 8
Brushheads for:
KH107
Toothbrush
8,00 € €
Payment method
(Signature)
Sender / Orderer
(please complete in block capitals)
Surname, first name
Street
Post code/town
Telephone
€
Cheque payment
✄
Add. 2,00 € p&p.
(Location, Date)
IB_KH107_E269_UK_4A 30.08.2007 13:46 Uhr Seite 13