KOI FOOD 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 Billing Information  
Last Name*
First Name*
Street Address*
City*
State/Province*
Country*
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?

KOI FOOD
QTY
 FORMULA
PELLET
BAG SIZE
BAG PRICE
TOTAL
NEW! Toyoma Koi - Breeder Formulas
ALL-SEASON PRO

ALL-SEASON PRO

PREMIUM PRO

PREMIUM PRO

Dainichi Koi Formulas
ALL-SEASON

ALL-SEASON

GROWTH PLUS

GROWTH PLUS

PREMIUM

PREMIUM

COLOR INTENSIFIER
COLOR INTENSIFIER

ORDER NOTES:

• All Pellets are FLOATING.
• SINKING Pellets are sometimes available upon request.
• Small / Medium Mix Pellet is available in 5.5 lb only.

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

 

Total 5.5 lb bags
  Enter

 

Total 11 lb bags
  Enter

Total 22 lb bags
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*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

     

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