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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 _____________________

Street ______________________________________ City ____________________

State __________ Zip _______________ Phone ___________________________

Ship to: (if different than above)

Name ______________________________________________________________

Street ______________________________________ City ____________________

State __________ Zip _______________ Phone ___________________________

Items Ordered: (if more than 6 items attach another form)

Qty	Price	Item ID	Item Name

Card Information (Visa, Mastercard, AMEX, and Discover Accepted):

Card Number ____________________________________ Exp Date ______________

Name on Card _________________________________________________________

Total Due:
Total Ordered	_____________________
IL Sales Tax	_____________________ (7.0% Illinois address only)
Shipping	_____________________
Total Due	_____________________

Shipping Rates:

$6.95 for total order between $0.00 and $60.00
$8.45 for total order between $61.00 and $100.00
$10.95 for total order between $101.00 and $150.00
$12.95 for total order over $151.00

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A State Street Products, LLC Company
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All merchandise is officially licensed and manufactured under authorized agreements held by their respective licensees. All team insignias, logo colors, designs, and products are approved by the selected university or college and are processed through third party licensing representatives, if applicable.

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