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ORDER FORM
FOR REPLACEMENT GLASS LID, CERAMIC POT
Price per Ceramic Pot (includes shipping and handling $ 17.00)
Price per Glass Lid (includes shipping and handling $ 12.00)
Please send a MONEY ORDER only (no cash or personal checks) ,
payable to Wachsmuth & Krogmann Inc. to the following address:
Wachsmuth & Krogmann Inc,
1800 Nicholas Blvd.
Elk Grove Village, IL 60007
Kindly fill in your information below and send together with your
Money Order
Name
Street
City
State
ZIP
Date
Quantity of Item Ceramic Pot @
$
Quantity of Item Glass Lid @
$
Total amount $
16