If you were to enter in a valid email address of someone who did order something, they give up a ton more data. I personally like the notion of having an entire account control panel for your users, one section being shipping where you can spell all this out.

Right now, I know someone, not personally, but someone pretty high up at google.com that has ordered one of these on a whim. I would also estimate, that if the product was backed by VC or Angels, this person would not have had to order one, but a box of 10 would have been and delivered to his whatever his location was at the time.