Intern: ..............................
..............................
Excl. the applicable shipping costs
We hereby order the following items:
Amount Item Price
(please list) (please check) (plus VAT.)
...............
...............
...............
...............
Cleaning agent 5kg
Clamping cone for cars
Clamping cone for trucks
Adapter for 14"-Wheels
40,00€
94,00€
98,00€
48,00€
clean wheel solutions
GmbH
2
FAX to: +49 (0) 1805 / 881333-0*
Delivery Address (Stamp):
Serial Number: ...................................
Year of Construction: .........................
Company:...........................................
Street: ................................................
Place:..................................................
Billing Address:
(if different from delivery address)
Company:................................................
Street: ....................................................
Place:......................................................
Telephone:..............................................
Date: ........................... Signature: ....................................
Order Form / Replacement Part Procurement
Order Form / Replacement Parts Procurement
Tiresonic GmbH
Osterwalder Straße 12
D-87496 Hopferbach
Internet: http://www.tiresonic.de
Telephone +49 (0) 1805 / 881333-3*
Telefax +49 (0) 1805 / 881333-0*
* 0,14Euro/Min from the German landline network / mobile phone charges may vary, max. 0,42 Euro/Min.
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