ORDER FORM


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.

INFORMATION & MERCHANDISE ORDER FORM

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.

-Mr. -Ms. -Mrs. -Dr.

Name (First,) : Last :
State/Province :

Address, Street:

City : State/Province : Postal/Zip Code :

Country :

Telephone I can be reached at : Area Code Number : Extention :

Second Number I may be reached at :

Fax : My E-Mail address is :

You may also reach me at my following, second E-Mail address of mine:

Please notice that we cannot answer inquiries unless provided with at least one e-mail address

Before I order I would like to clarify the following (enter your request for clarification in the white area below):

I AM TENTATIVELY INTERESTED IN THE FOLLOWING ITEM(S)

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 detailed description below:

Item Description (1st. priority): Item's Lot/stock Number :
Item Description (2nd priority): Item's Lot/stock Number :
Item Description (3rd. priority): Item's Lot/stock Number :
Item Description (4th. priority): Item's Lot/stock Number :
Item Description (5th. priority): Item's Lot/stock Number :
If ordering a ring please enter ring size :
FOR NOW E-MAIL TO ME, ONLY, THE ITEM(S) AVAILABILITY STATUS AND PROVIDE ME WITH ALL OTHER PERTINENT INFORMATION.

I WOULD LIKE TO ORDER THE ABOVE ITEM(S)

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):

    Wire Transfer (Fast, efficient, solid receipt & easily-trackable)

    Personal Check

    Money Order

    Bank Draft

    Certified Check

    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 !)

      VISA

      MASTER CARD

      AMEX

    Credit Card Company Check

    Other (specify) :

Where on the 'Net' or on the 'Web' did you encounter our site ?-please mention name of "search engine" or Shopping Mall, and word(s) used in search:

To cancel/Reset press-

E-MAIL TO VAN-DAAZ YOUR QUESTIONS AND SUGGESTIONS : vandaaz@vandaaz.com

Back to Van-Daaz's Main Menu