KAKERU Standard model order form

Name of person who ordered
Tel Required - -

※ Please enter a number where you can be reached during the day.

Email Required
Name of user
User’s race experience
Will this KAKERU Standard
model be your first (second, etc.)
racing wheelchair?

Requested measurement dates

* Available 9:00-17:00
(closed on Saturday, Sunday,
national holidays, and long holidays)
Example: for July 1, 2014, enter “2014/07/01”
1st choice
2nd choice
3rd choice
4th choice
Questions or comments