Pride of Iowa Barbershop Chorus
2008 Singing Valentine Order Form

To order or request information just fill-in the blanks below.
Privacy Statement: None of this information will be used for any other purpose but to communicate
with you about this Singing Valentine order.

This Singing Valentine is given BY:

      Your Name: 
           Address:  
                  City:  State: Zip:
Your email address:
(To keep this Singing Valentine gift a surprise, DO NOT give an email address that the Singing Valentine
 recipient has access to.  Your email address will only be used to communicate with you about your order.)

 Your home phone:  Your work phone:
  Your cell phone:

** We will call or email you to confirm your order. **

This Singing Valentine is to be delivered TO:

Recipient Name:   
Delivery location: 
              (Please enter above, the name of the business where the delivery is to be made.)
Delivery Address:  
City:                                    Zip:
Please enter directions to delivery location, delivery times requested,
and other special instructions:

Your  Singing Valentine Package:
(Two Love Songs, a silk rose and personalized card):   $45.00
(Please add $15.00 for delivery with-in a 15 minute time window.)

VISA and MASTERCARD accepted

Choose: MasterCard        Visa   
Card Number:
Expiration date (MM/YY)
Name on credit card:
(Your credit card will not be charged until after the Singing Valentine delivery.)

I prefer not to give my credit card information over the internet.

I will pay with cash or check.  Please call me for arrangements.
Payment must be received before the Singing Valentine will be delivered.

Sorry, no COD's. Please call (515) 210-5659 with questions.

Please enter questions or comments here:

Please check to see that all the information entered is correct.
Click "Submit - Place Order" if correct, click "Clear Form" to start over.