Current Customer Verify
All fields are Required

Kokosa Account Number


include area code

Delivery Location



Credit Card Information
To save you time when ordering we will keep this on file at the office (not on the website).
Your card will not be charged until the day of delivery.
Use card on file with last 4 digits

Use card below this time only

Use card below as the new card on file

Credit card number

Credit card expiration
Month Year

Credit card CVV       what's this?

Name on card

Billing Information
leave blank if same as above.
This is the address where you receive your credit card statement.



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