(Location, Date) (Signature)
PAYMENT METHOD
Bank Credit Transfer
=
ORDER CARD NKZ 3 A1
QUANTITY ORDERED
(max. 3 sets per order)
NAME OF ARTICLE COST P. UNIT TOTAL SUM
www.kompernass.com
€
€
Postage and packaging
3 €
+
► Set of 8 Toothbrush heads
5,50 €
