Drive Green Order Form
(1) KT2050 DriveGreen™ One-Shot Tire Inflator : (Adjustible preset pressure: 20 - 50 PSI)
Price: $ 24.95 x Quantity:_________ = Subtotal(1): $_____________
(2) SR60W Button Silver Oxide Battery : (Each package contains 2 pieces of Batteries)
Price: $ 1.95 x Quantity:_________ = Subtotal(2): $_____________
(3) EIW20-50 Easy-Inflation™ Wand : (Fixed preset pressure:___________PSI)
Price: $ 19.95 x Quantity:_________ = Subtotal(3): $_____________
Subtotal (1) + (2) + (3) : $__________; +
Tax: $__________(8.25% only for Texas residents)
+ Shipping & Handling: $5.00
= Total: $_______________
___I’d like to pay by the attached check.
Shipping Address:
Receiver’s Name: ________________________;
Street: ______________________________
City:
__________________________State/Province:_______________________
ZIP/Postal Code:
_____________________Country: ____________________________
Phone: _______________ Fax: _______________
E-mail: ____________________
Signature: __________________________Date:
______________________________
Drive Green, Inc.
17414 Fountainview
Cir.
Sugar Land, TX 77479,
USA