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                                      A/C Brace Printable Order Form

PopupGizmos A/C Brace Order Form

Your Name:______________________Your Email:_______________

Your Address:

         Street:_______________________________

         City:   _______________________________

         State: _______________________________

         Zip Code:___________

Make, Model & Year of your camper:___________________________________

The A/C Cover Saver Brace.......................$19.95

Shipping: $6.95 US, $9.95 Canada............___________

Texas residents add 8.25% sales tax .........___________

                                        TOTAL.............___________

Mail the form with your check or money order to:

PopupGizmos                                          

34 Green View Circle

Richardson, TX 75081

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