CICHLID ORDER FORM
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
 (Customer Information
First Name
Last Name
  Existing Customer (Input Changes Only)
   Note: E-mailed Final Invoice also serves as your Order Confirmation.
E-mail Required
Phone Alt Phone Include Area Code
Bill To Street Address
Bill To City / State / Zip  City State Zip
Bill To Foreign State / Country  Foreign State Country
 
Ship To Customer Information Same as "Bill To"   (Skip "Ship To")
Ship To Street Address If different from "Bill To"
Ship To City / State / Zip  City State Zip
 
Notify you of specials or new products?
How did you hear about us?
Payment Method
Credit Card Number Exp Date Month Year
Credit Card Security Code  CVC Code  3 Digit No. on Signature Panel (Required for New and Repeat Orders)

CICHLID FOOD
QTY
  FORMULA
PELLET TYPE
PELLET SIZE
  BAG SIZE & PRICE
TOTAL
XL Pro
Floating

XL Pro
Sinking

Ultima Krill

Floating

Ultima Krill

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
SUB-TOTAL (EXCLUDES Shipping & Tax)*
Total 8.8 oz bags
  Enter
Total 1.1 lb bags
  Enter
Total 5.5 lb bags
  Enter

*7.75% Sales Tax: California Residents Only.

SHIPPING & HANLDING

Default Shipping: UPS Ground

Up to 1.1 lb (Cheapest Way)
Priority Mail
$6.00
International / AK / HI / PR
Priority Mail
Weight Dependent
All Orders Greater Than 1.1 lb
UPS Ground
Weight Dependent
Questions, Comments or Special Requests

                     

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