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Order Form

VanErt Enterprises Order Form

Note:  I do not take credit cards, therefore you will not see a credit card button to click on to order.  You just need to fill out the form to the right.  I will confirm your order and total amount due by email and we will work out payment arrangements at that time.  You will not receive any other confirmation unless there is a problem. It may take me a day to confirm the order, but I will do my best.  Providing your correct email address on the form below is very important!  This is the only way I can get back to you if there is a problem.

Follow the directions below and DO NOT click the SUBMIT button until you have filled out all of the fields on the form correctly.  Please note that the enter key on your keyboard acts as a submit button, do not use the enter key to go from field to field, use the tab button instead.  If you use the enter key while you are filling out the form it will submit the incomplete form at that time and you'll have to restart the order form process.

IMPORTANT:

Please fill out all fields including:

1.  Full Name 2.  Address
3.  City 4.  State
5.  Zip Code 6.  Phone
7.  Email Address 8.  Quantity

Thank you and enjoy the bluebirds!

Contact us:

22684 US Highway 69

Leon, Iowa  50144

641-446-6471

fvanert@grm.net

Please fill in all the blanks below with the following contact and shipping information:

Name
Shipping Address
City
State
Zip Code
Phone
E-mail

Confirm

E-Mail

Please fill in the quantity of each item you would like to order:

QTY DESCRIPTION 






Additional Questions or Comments?  Enter them in the box below:










Everything Correct?  If yes, click SUBMIT ORDER.




 


        

      

    

  




 

Created
by The Cyber Solution.

Copyright © 2007 The Cyber Solution. All rights reserved.

Revised: January 07, 2008
 .