VAN-DAAZ's ORDER FORM

<head><title>VAN-DAAZ's ORDER FORM</title> <META name="keywords" content="diamonds, diamond, GIA certified diamonds, G.I.A certified diamonds, selling diamonds, diamonds wholesale, diamonds retail, buying diamonds, diamond sale, loose diamonds, diamond purchase, wedding diamond ring, rings, diamond rings, engagement ring , diamond jewelry, jewelry, jewellery, diamond jewellery, fine jewelry, tennis bracelet, tennis bracelets, diamond prices, round brilliant cut, princess cut, marquise cut, oval cut, heart shape, diamond information, Lazare Kaplan, Lazare cut, Lazare diamond, Lazare diamonds, Lazare Kaplan diamond, Lazare Kaplan diamonds, Lazare Kaplan cut, diamant, diamants, diamantaire, diamantaires, diamonds Canada, diamonds Montreal, E.G.L diamonds, EGL Diamonds, IGI Diamonds, I.G.I diamonds, diamond shopping tips, Diamond theory, diamond clarity, diamond color, diamond colour, 4 C, 4 Cs, 4 C's, 4 cs, diamond solitaire, diamond solitaires, Tiffany, Tiffany setting, diamond proportions, diamond information, diamond grading, diamond importers, diamond cutting, diamond cutters, diamond manufacturers, diamond brokers, diamond selection, ideal cut diamonds, ideal cut diamond, Tolkowsky, Marcel Tolkowsky, Tolkowsky cut diamonds, Rappaport Diamond Report, carat, FL, IF, VVS1, VVS2, VS1, VS2, SI1, gem, gems, precious stones"> <META name="description" content="Diamonds !!! Van-Daaz's Diamond jewelry Order-Form. Yes, at Van-Daaz diamonds are for ever...y one!"></head> <BODY BGCOLOR="#D8D8BF"> <CENTER><IMG SRC="http://www.vandaaz.com/ORDERF.GIF" WIDTH=400 HEIGHT=88 BORDER=3 ALT="ORDER FORM"></CENTER> <FONT FACE="Arial, Helvetica, helv, sans-serif" SIZE="2"> <P><CENTER> <B><EM><br>Van-Daaz is committed to the principle of maintaining all personal information submitted and/or communicated to it strictly confidential and to not allow access by any third party to it nor to transmit, lend, lease, sell or otherwise pass it to any such third party whatsoever. Nor will Van-Daaz use such information to initiate unsolicited phone calls or to mail printed unasked for material.</EM> <HR> <P> <H5>INFORMATION & MERCHANDISE ORDER FORM</H5> </b> </CENTER> <HR> <FORM METHOD="POST" ACTION="http://www.vandaaz.com/cgi-bin/orderf_form.cgi"> <P>Please notice: Your name, city, country of residence and your primary e-mail address are required fields without which we cannot answer your inquiry. Your telephone number will be required by the carrier if you proceed to affect an order at any point. <P><CENTER><INPUT TYPE="RADIO" NAME="nametitle" VALUE="Mr.">-Mr. <INPUT TYPE="RADIO" NAME="nametitle" VALUE="Ms.">-Ms. <INPUT TYPE="RADIO" NAME="nametitle" VALUE="Mrs.">-Mrs. <INPUT TYPE="RADIO" NAME="nametitle" VALUE="Dr.">-Dr.</CENTER> <P> <FONT SIZE="1">Name (First,) : <INPUT NAME="firstname"> Last : <INPUT NAME="lastname"> <BR>State/Province : <INPUT NAME="state"> <P>Address, Street: <INPUT NAME="address_street" SIZE=50> <P>City : <INPUT NAME="city"> Postal/Zip Code : <INPUT NAME="zip" SIZE=9> Country : <INPUT NAME="country"> <P>Telephone I can be reached at : Area Code <INPUT NAME="area_code" SIZE=11> Number : <INPUT NAME="tel" SIZE=9> Extention : <INPUT NAME="extention" SIZE=6> <P>Second Number I may be reached at : <INPUT NAME="tel2"> <P>Fax : <INPUT NAME="fax"> My E-Mail address is : <INPUT NAME="email"> <P>You may also reach me at my following, second E-Mail address of mine: <INPUT NAME="email2"> <P> <B>Please notice that we cannot answer inquiries unless provided with at least one e-mail address</B> <P>Before I order I would like to clarify the following (enter your request for clarification in the white area below): <P><TEXTAREA NAME="message" ROWS="10" COLS="60"></TEXTAREA> <HR> <P><CENTER><FONT SIZE="2">I AM TENTATIVELY INTERESTED IN THE FOLLOWING ITEM(S) </font></CENTER><P><FONT SIZE="2"><CENTER>Important: Please indicate 3-5 items retrieved by our Diamond Explorer (tm), in your order of priority and preference, to guarantee availability of at least one, and start by providing their <B>detailed</B> description below: </center></font> <BR> Item Description (1st. priority): <INPUT NAME="item1"> Item's Lot/stock Number : <INPUT NAME="cat1" SIZE="10"><BR> Item Description (2nd priority): <INPUT NAME="item2"> Item's Lot/stock Number : <INPUT NAME="cat2" SIZE="10"><BR> Item Description (3rd. priority): <INPUT NAME="item3"> Item's Lot/stock Number : <INPUT NAME="cat3" SIZE="10"><BR> Item Description (4th. priority): <INPUT NAME="item4"> Item's Lot/stock Number : <INPUT NAME="cat4" SIZE="10"><BR> Item Description (5th. priority): <INPUT NAME="item5"> Item's Lot/stock Number : <INPUT NAME="cat5" SIZE="10"><BR> If ordering a ring please enter ring size : <INPUT NAME="ringsize" SIZE="4"><BR> <CENTER><INPUT TYPE=RADIO NAME="ACTION" VALUE="Call me">FOR NOW E-MAIL TO ME, ONLY, THE ITEM(S) AVAILABILITY STATUS AND PROVIDE ME WITH ALL OTHER PERTINENT INFORMATION. </CENTER><P><CENTER><INPUT TYPE=RADIO NAME="ACTION" VALUE="BUY">I WOULD LIKE TO ORDER THE ABOVE ITEM(S)</center> <P><STRONG>And pay for it by the following means - Please contact me to finalize the transaction (certain limitations may apply--in which case you will be contacted): </STRONG><UL><STRONG> <P><INPUT TYPE="RADIO" NAME="pay" VALUE="WT">Wire Transfer (Fast, efficient, solid receipt & easily-trackable) <P><INPUT TYPE="RADIO" NAME="pay" VALUE="PC">Personal Check <P><INPUT TYPE="RADIO" NAME="pay" VALUE="MO">Money Order <P><INPUT TYPE="RADIO" NAME="pay" VALUE="BD">Bank Draft <P><INPUT TYPE="RADIO" NAME="pay" VALUE="CR">Certified Check <P><INPUT TYPE="RADIO" NAME="pay" VALUE="CC">Credit Card (a 3.25%, to 4.00% charge, depending on card, will be added to price; Only partial amount may qualify.For your own safety do not submit Credit Card Number now !) <UL><INPUT TYPE="CHECKBOX" NAME="VISA"> VISA <P><INPUT TYPE="CHECKBOX" NAME="MC"> MASTER CARD <P><INPUT TYPE=CHECKBOX NAME="AMEX"> AMEX</UL> <P><INPUT TYPE="RADIO" NAME="pay" VALUE="CCC">Credit Card Company Check <P><INPUT TYPE="RADIO" NAME="pay" VALUE="OT">Other (specify) : <INPUT NAME="other_pay"></strong></UL> <HR> <P>Where on the <EM>'Net'</EM> or on the <EM>'Web'</EM> did you encounter our site ?-please mention name of "search engine" or Shopping Mall, and word(s) used in search: <P> <INPUT NAME ="found_us_at" SIZE=50> <P> <INPUT TYPE="SUBMIT" VALUE="SEND TO VAN-DAAZ"> <P>To cancel/Reset press- <INPUT TYPE="RESET" VALUE="Oops !"> </font> </FORM> <HR> <P> <font size="1">E-MAIL TO VAN-DAAZ YOUR QUESTIONS AND SUGGESTIONS :</font> <EM><A HREF="MAILTO:vandaaz@vandaaz.com">vandaaz@vandaaz.com</A></EM> <P><A HREF="http://www.vandaaz.com/dmenu.htm"><IMG SRC="http://www.vandaaz.com/BUTTON.GIF" ALIGN=MIDDLE border="0">Back to Van-Daaz's Main Menu</A> </font> </body>