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