Balance KH 107 Operating Instructions Manual page 13

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