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If
you would like to order by mail or fax, please print this form
(page 1) by
using your browser's "print" button or print our
printable form (pdf). Complete the form and fax to
253-276-0723 or send with a personal check or money order made out to
State Street Products, LLC to: |
State
Street Products, LLC
100 S. Atkinson Road, Unit 116-106
Grayslake, IL 60030 |
| Sold To: |
Name ___________________________________ Email _____________________
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Street ______________________________________ City ____________________
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| State __________ Zip _______________ Phone
___________________________ |
Ship to:
(if different than above) |
Name ______________________________________________________________
|
Street ______________________________________ City ____________________
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| State __________ Zip _______________ Phone
___________________________ |
Items Ordered: (if more
than 6 items attach another form)
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Qty |
Price |
Item ID |
Item Name |
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Card Information (Visa, Mastercard,
AMEX, and Discover Accepted): |
Card Number ____________________________________ Exp Date
______________
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Name on Card _________________________________________________________
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Total Due: |
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Total Ordered |
_____________________ |
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IL Sales Tax |
_____________________
(6.5% Illinois address only) |
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Shipping |
_____________________ |
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Total Due |
_____________________ |
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Shipping Rates:
$5.50 for total order between $0.00 and $60.00
$7.35 for total order between $61.00 and $100.00
$9.45 for total order between $101.00 and $150.00
$11.95 for total order over $151.00
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