Dainichi Cichlid Food Order Form

CICHLID ORDER FORM

Fill Out Order Form and SUBMIT by E-mail

or Select PRINT on your Web Browser and FAX or MAIL to:

580 N Berry Street
Brea, CA 92821 USA
Tel 714.672.0855 • Fax 714.672.0852

For information or comments please contact us: Email info@dainichi.com or Toll Free 877.366.3434 (FOOD-4-FISH)

Customers "Bill To" Information
Last Name
First Name
Street Address
City
State / Province
Zip
Customer "Ship To" Information	Same as Bill To Information
Street Address
City
State/Province
Zip
Phone	Include Area Code
Fax	Include Area Code
E-mail
Select Payment Method
Credit Card Number
Credit Card Security Code	CVC Code 3 Digit Number on Signature Panel
Credit Card Expiration Date	Month Year
Order Confirmation?	Please Email Order Confimation
If any order questions ... Contact Method
Notify you of specials or new products?
What types of food are you interested in?
How did you hear about us?

CICHLID FOOD
QTY	FORMULA	PELLET TYPE	PELLET SIZE	BAG SIZE & PRICE	TOTAL
	XL Pro	Sinking*
	XL Pro	Sinking*
	Ultima	Floating
	Ultima	Sinking
	Color Supreme	Floating
	Color Supreme	Sinking
	Veggie Deluxe	Sinking
	Veggie Deluxe	Sinking
	Veggie FX	Sinking
	Veggie FX	Sinking
	Color FX	Sinking
	Color FX	Sinking
*Small XL Pro pellet is slow-sinking			SUB-TOTAL (EXCLUDES Shipping & Tax)*

*7.75% Sales Tax: California Residents Only.

Shipping & Handling

Shipping by UPS Ground Unless Specified Otherwise.

Up to 1.5 lbs (and all shipments to PR, AK and HI)	Priority Mail	$6.00
1.5 lbs and up	UPS	Weight Dependent

Questions, Comments or Special Requests