JACKPOT ORDER & INQUIRY FORM
Thank you for your inquiry.
For inquiries to JACKPOT, orders for KIZAMI CLOTH and special parts, please fill out the form below and send.
We will reply to you from JACKPOT OVERSEA DIVISION.
JACKPOT OVERSEA DIVISION
responsible party SOHEI KAKUTA
YOUR NAME（Required）
YOUR NAME（Required）
E-MAIL ADDRESS（Required）
E-MAIL ADDRESS（Required）
ADDRESS LINE 1（Required）
Due to the influence of COVID-19, we cannot ship to some countries or regions. In case of product order, we will check the delivery status, so please enter your address.
ADDRESS LINE 1（Required）
ADDRESS LINE 2（Option）
ADDRESS LINE 2（Option）
CITY（Required）
CITY（Required）
STATE/PROVIENCE/REGION（Required）
STATE/PROVIENCE/REGION（Required）
COUNTRY（Required）
COUNTRY（Required）
zip/postal code (option)
zip/postal code (option)
YOUR PHONE NUMBER（Required）
Please enter your telephone number as it will be included in the invoice when the product is shipped.
YOUR PHONE NUMBER（Required）
YOUR MESSAGE（Required）
YOUR MESSAGE（Required）
SEND
×
JACKPOT ORDER & INQUIRY FORM