NAME: ______________________________________________________________________________________
ADDRESS: ___________________________________________________________________________________
_____________________________________________________________________________________________
PHONE NUMBER _____________________________ Email Address (Optional) __________________________
Quantity ______ Model Number __________ ( @ $US __________ each) = __________________
Quantity ______ Model Number __________ ( @ $US __________ each) = __________________
Quantity ______ Model Number __________ ( @ $US __________ each) = __________________
Quantity ______ Model Number __________ ( @ $US __________ each) = __________________
Quantity ______ Model Number __________ ( @ $US __________ each) = __________________
Quantity ______ Model Number __________ ( @ $US __________ each) = __________________
Quantity ______ Model Number __________ ( @ $US __________ each) = __________________
Quantity ______ Model Number __________ ( @ $US __________ each) = __________________
Sub Total =__________________
For orders within California only, 8.25% of Sub Total =__________________
Shipping US Postal: (Priority Mail = FREE)
Choose one (Express Mail* = US$15.00)
(International orders must choose Global Priority Mail* = US$19.00) =__________________
(*Express/International Shipping not refundable with product returns)
TOTAL ORDER =__________________
Make one check per order, payable to Dakiom. Your order will be shipped after the check/money order is cleared.
MAIL YOUR ORDER AND CHECK TO: DAKIOM
3056 Scott Blvd, Suite C