Alchem Incorporated
314 East 195th St.
Euclid, Ohio 44119
Ship To:
Name ________________________________________________________
Address ________________________________________________________
City, State, Zip ________________________________________________________
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Model: Description: Quantity: Price: Total:
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Prices On Shipments Within The US: All prices are in US dollars. Quoted prices include local tax and shipping for orders from Ohio and other parts of the United States.
Payment On Shipments Within The US: Payment may be in the form of a personal check, or money order. We are unable to take credit card payments.

Print or otherwise copy this page and mail it to the above return address along with payment. Allow up to two weeks for delivery.