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By Mail:
1. read product information under "PRODUCTS / ORDER ONLINE" Tab
2. print this page (for best results, set all margins to ".25" and set orientation as "landscape")
3. fill out requested information
4. mail with check or provide credit card information to: Great States Products
PO Box 1011
Lancaster, SC 29721
By Phone: Call us at 704-351-0787 or 800-440-3010.
By Fax: Please fill out the following order form (order & credit card information) and fax to 520-842-8742.
Your Name __________________________ Tel.No. (_____)_________________
eMail Address __________________________
Company Name __________________________ (If applicable)
Street Address __________________________ (Shipping Address - NOT a PO Box)
City __________________________
State _________________
Zip Code _________________
This a Residential Address ( ). This is a Business Address ( ).
___________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
SALE
DESCRIPTION PRICE QUANTITY TOTAL
Roof-Be-Clean Blend #1 for Highly Stained Roof, 1-Gallon $36.70 ________ _________ (Regular $48.95)
Roof-Be-Clean Blend #2 for Lightly Stained Roof, 1-Gallon $36.70 ________ _________ (Regular $48.95)
Roof-Be-Clean Blend #3 for Clean Roof Protection, 1-Gallon $36.70 ________ _________ (Regular $48.95)
Roof-Be-Clean Blend #1 & Blend #3 Kit, 1-Gallon each $66.55 ________ _________ (Regular $88.95)
Roof-Be-Clean Blend #1, 2-Gallons $66.55 ________ _________ (Regular $88.95)
Roof-Be-Clean Blend #2, 2-Gallons $66.55 ________ _________ (Regular $88.95)
Roof-Be-Clean Blend #3, 2-Gallons $66.55 ________ _________ (Regular $88.95)
Easy Moss Scraper with Handle $49.95 ________ _________
Shipping Charges (Enter Using S&H Table Shown Below) ................................ ___________
Sub-Total ___________
Add Sales Tax (South Carolina shipments only) at 7.0% (of Sub-Total) ___________
Add Sales Tax (North Carolina shipments only) at 8.25% (of Sub-Total) ___________
Order Total ___________
Credit Card Information:
Type of Card: Visa ( ), Master Card ( ), Discover ( ), American Express ( )
Your Full Name as it Appears on the Card ______________________________
Account Billing Address ______________________________________
City / State / Zip Code ______________________________________
Account No. ________________________ Expiration Date ____________ CVV ______ (Card Security Code)
How to find the security code: For Visa, MasterCard and Discover, look on the back of your credit card. In the signature strip there are several numbers, some of which may be part of your credit card number. The last 3-digits in the signature strip is the CVV card security code. For American Express cards, the CVV code is a 4-digit code on the front, on the right hand side above your credit card number.
Check Information:
Check Number ______________ Check Date ______________ Check Amount ___________
(Please Make Checks Payable to "Great States Products LLC")
Shipping & Handling Charges Table:
$7.80 + 3.25 per Gallon of Roof-Be-Clean® (i.e., $11.05 for 1-gallon, $14.30 for 2-gallons, etc.)
+ 4.10 per Easy Moss Scraper®
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