Customer Price Quote
Please supply any missing contact and shipping information and verify all option selections,
then print and mail your order and payment to Mimicon Corporation. Quotes are valid for 30 days.
Contact Mimicon for estimated delivery date.
First Name Last Name
Company
Phones
Phone Phone 2
Cell Phone FAX
Email Website
Address
Street
City State/Province
Postal Code Country
Address <========= (For international orders: please enter address in the format required by your country)

Order Information
Order Date Quoted
Form of payment
Special Handling, Shipping, or Contact Rrequirements:

Ordered Items Checklist:
Part
Selections
(discount applies when 3 or more options are ordered at the same time)
List Price

Discount Price
(when 3 or more
options are ordered)
Order
Base Order (select only one item from this section)
Torso & Head
(includes oral cavity)

Yes No

$980.00
Torso & Head
(oral cavity not included)		 Yes No
$920.00
Torso
(Basic, head not included)		 Yes No
$795.00
Breasts & Head
(Includes oral cavity)  		Yes No
$595.00
Breasts Only Yes No
$395.00
Hips Only
(Includes vagina, except for orders to Japan)  		Yes No
$495.00
Head Only
(Includes oral cavity)		 Yes No
$245.00
Options (when ordered with one of the selections above)
Vagina (Included*)
* except for orders to Japan		 Yes No
For orders to Japan, call or write for details
Teeth Yes Discount No
$35.00
$31.50
Tongue Yes Discount No
$35.00
$31.50
Wig
 Select a wig and color below. Prices will display here ===>

Paula

 Yes Discount No
$55.00
$49.50
  

Farah

 Yes Discount No
$59.00
$53.00
  

Lizie

 Yes Discount No
$64.00
$57.50
  

Elvira

 Yes Discount No
$73.00
$65.75
  

Lydia

 Yes Discount No
$90.00
$81.00
  

Carmen

 Yes Discount No
$90.00
$81.00
  

Bambi

 Yes Discount No
$90.00
$81.00
  

Topaz

 Yes Discount No
$92.00
$83.00
  

Floris

 Yes Discount No
$92.00
$83.00
  

Vanessa

 Yes Discount No
$94.00
$84.50
  

Temptress

 Yes Discount No
$101.00
$91.00
  

Carol

 Yes Discount No
$93.00
$83.75
  

Debora

 Yes Discount No
$96.00
$86.50
  

Casandra

 Yes Discount No
$96.00
$86.50
  

Radiance

 Yes Discount No
$108.00
$97.25
  

Constellation

 Yes Discount No
$109.00
$98.00
  

Electra

 Yes Discount No
$110.00
$99.00
  

Solar

 Yes Discount No
$105.00
$94.50
  

Ultima

 Yes Discount No
$104.00
$93.50
  

Desire

 Yes Discount No
$114.00
$102.50
  

Affair

 Yes Discount No
$114.00
$102.50
  

Aquarius

 Yes Discount No
$114.00
$102.50
  

Paulina

 Yes Discount No
$114.00
$102.50
  

Eyes

 Yes Discount No
$100.00
$90.00
Eyelashes Yes Discount No
$30.00
$27.00
Lipstick
 Yes Discount No
$25.00
$22.50
Nipples (Included) Yes
Lubricant (Included)
Sample size (1 Oz.)		 Yes
Lubricant (8 Oz.) Yes Discount No
$20.00
$18.00
Cleaning Kit Yes Discount No
$25.00
$22.50
3D Recording Yes Discount No
$39.00
$35.10
MiniDisc Player Yes Discount No
$400.00
$360.00
Make-up Kit Yes Discount No $52.00 $46.80

Pubic Wig, Natural

 Yes Discount No
$400.00
$360.00
Pubic Wig, Trimmed
 Yes Discount No
$300.00
 $270.00
Vaginal Opening Kit
(for orders to Japan only)		 Yes Discount No $125.00 $112.50
Shipping Carrier
Carrier & Service
Shipping & Crating (Required for Torso Front (with or without head)
Shipping Crate
(w/ blanket, and popcorn)		 Yes No
$85.00
Shipping & Insurance
 Yes No
$80.00 for 5-Day UPS Ground
Service for US orders in the 48
Contiguous States. All other
orders call for quote.
Shipping & Crating (Required for Breasts only, Head only, or Breasts & Head)
Shipping & Insurance
 Yes No
$40.00 for 5-Day UPS Ground
Service for US orders in the 48
Contiguous States. All other
orders call for quote.
Shipping Carton
(w/ blanket, and popcorn)		 Yes No
$10.00
Tax (when applicable)
Sales Tax
(for California orders only)		 Yes No
California residents add 7.75%
of all charges (except shipping)
Grand Total Calculate the tax and total by hand 

 
    Fill in this form and FAX it to us if one or more of the following 
    is true:

    • your shipping address is outside the 48 contiguous states

    • you want to ship in any other manner than 5-Day UPS Ground service

    • this is an international order

    • you have special handling requirements

    • you desire custom work

We will verify the shipping costs to your address and return the completed quote to you. Please provide all the necessary contact information (address, postal code, email address, FAX) in order for us to process your quote.

Otherwise, if the information is complete, this form is your order form. Print this form and mail it
(along with your payment) to the following address:

Mimicon Corporation
3638 N. Rancho Drive, Suite 6
Las Vegas, NV 89130

Phone: (866) 8-CYBORG

Note:
Orders are not considered to have been placed until we receive your order form and payment.
This is what establishes your place in our order fulfillment queue.