By Mail:

1. read product information under "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 LLC

                                                                             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 (     ).

___________________________________________________________________________________________________________________________

DESCRIPTION                                                                                PRICE    QUANTITY     TOTAL 

ZincShield^®  2.5" Wide Zinc Strip, 1-Roll of 50 feet *          $36.50    ________   _________

       (SAVE $13.00)

ZincShield^® 3.5" Wide Zinc Strip, 1-Roll of 50 feet *           $55.60    ________   _________

        (SAVE $13.90)

  ZincShield^® 6.0" Wide Zinc Strip, 1-Roll of 50 feet *          $175.50    ________   _________

        (SAVE $44.00)

ZincShield^® Nails (27 Nails with EPDM Rubber Washers)                               $  2.00    ________   _________

GSP-95^® ZincShield^® Adhesive, 1-Tube, 10.1 Fl.OZ.                                    $  4.99    ________   _________

  LiquidZinc^® - Stain Stopper, 1-Gallon                                  $41.25    ________   _________      

        (SAVE $7.30)

  LiquidZinc^® - Stain Stopper, 2-Gallons                                $73.45    ________   _________

       1-Gallon at Regular Price, 2nd Gallon at 50% OFF

        (SAVE $24.45)!

* - Please be sure to Add either ZincShield^® Nails or GSP-95^® Adhesive to Insure Correct Installation on Your Roof

   Shipping Charges  (Enter Using S&H Table Shown Below) ............................................  ___________

                                                                                                                        Sub-Total     ___________

   Sales Tax (South Carolina shipments) at 7.0% (of Sub-Total) .......................................  ___________

   Sales Tax (North Carolina shipments) at 8.250% (of Sub-Total) ......................................  ___________

                                                                                                  Order Total .....................  ___________

Credit Card Information:

       Type:  Visa (     ),   Master Card (     ),   Discover (     ),   American Express (     )

       Your Name as it Appears on the Card  ______________________________

       Account Billing Address   _________________________________________

       City / State / Zip Code    _________________________________________

       Account Number             _________________________________________

       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:

 $7.40 + 2.00 per Roll of 2.5" ZincShield^®
          + 2.50 per Roll of 3.5" ZincShield^®
          + 5.10 per Roll of 6.0" ZincShield^®
          + 0.50 per Tube of GSP-95 Adhesive
          + 0.30 per Bag of ZincShield^® Nails
          + 3.55 per Gallon of LiquidZinc^®