GJC Products Inc.
P.O. Box 3656
Huntington Beach , CA 92605 		PHONE/FAX (714) 848-7130
www.aquaclip.com
Note: When writing a check, make check payable to GJC Products, Inc.
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Order Form
Product Color Unit Price Quantity Ext. Price
AquaClip Red $3.00    
AquaClip White $3.00    
AquaClip Blue $3.00    
AquaClip Green $3.00    
AquaClip Yellow $3.00    
AquaClip Purple $3.00    
AquaClip Orange $3.00    
AquaClip Pink $3.00    
AquaClip Black $3.00    
AquaClip Light Grey $3.00    
AquaClip Dark Green $3.00    
AquaClip Dark Blue $3.00    
AquaClip Antique Blue $3.00    
AquaClip Coffee $3.00    
AquaClip Sage $3.00    
AquaClip Salsa $3.00    
AquaClip Translucent Red $3.00    
AquaClip Translucent Frost $3.00    
AquaClip Translucent Blue $3.00    
AquaClip Translucent Purple $3.00    
AquaClip Translucent Pink $3.00    
AquaClip Translucent Green $3.00    
AquaClip Translucent Lime $3.00    
AquaClip Translucent Yellow $3.00    
AquaClip Translucent Orange $3.00    
AquaClip Translucent Sky Blue $3.00    
AquaClip Translucent Smoke $3.00    
AquaClip Translucent Aqua $3.00    
AquaClip Translucent Bright Coral $3.00    
Subtotal  
California resident add 7.75% State Tax  
Shipping
-- NO CHARGE --
Total