I can guide you step by step if you wish.
But it might be better for you to press "Contact opnemen", to explain them you don't speak Dutch and if/how they ship to the US (I assume);
This is the translation of the contact form,
Voornaam: (first name)
Achternaam: (last name)
E-mail: (well duh)
Naam bedrijf: (your company)
Land: (country)
Opmerkingen: (your message)
U dient de characters xxx in het veld 'Controle veld' in te voeren:
(fill in the XXX code in the Controle Code field)
Controle code:
Regards,
Exq.