Electrode Steam Humidifier Manual

12. Fax Form - Order for spare parts
Fax Form
Lise-Meitner-Str. 3
24558 Henstedt-Ulzburg
Tel. +4904193/895-0
Order of spare parts
Please copy, fill in and fax to
Fax.No. +49(0)4193/895-33
unit type *______________ serial no.* ___________________
commission: ______________ order no.: __________________
quantity article article no.
date of delivery ____________forwarder _____________ shipment by ___________
delivery address (if different
from invoice address)
__________________________
__________________________
__________________________
__________________________
company stamp (delivery adress)
date/signature
* Order can only be processed if unit type and unit serial no. are filled in.
Page 42