Balance KH 107 Operating Instructions Manual page 11

Order card KH107
Quantity
ordered
Payment method
Cheque payment
Creditcard/Debitcard
Bank Transfer
(Location, Date)
(Signature)
Name of article
Brushheads for:
Toothbrush
Cost p. Unit
Set of 8
KH107
Add. £ 3,50 p&p.
Sender / Orderer
(please complete in block capitals)
Surname, first name
Street
Post code/town
Telephone
Total sum
£ 7,- £
£