Arab Family-Order Form

Price Quote Form - Wholesale
WaveShield Products

How to use this Form:

Use one Form per ORDER. To reduce "Banner", click on its "UPPER" right arrow.

Type in the Form, on screen response, (fill out applicable blanks).

Press "TAB" to move between blank spaces. When finished, please print the Form.

Complete all blanks you wish to receive a price quote for quantity orders. Retail prices are listed below.

Print completed Form and FAX it to DMS. Best time to send FAX is during the afternoon, after 2:00 PM (your time)

Retail Price for WaveShield Products
Click on Product name to view more detail - Bookmark this Page for future easy access
.

WaveShield 1000 for cellular (mobile) phones	$19.95	Quantity	Price Quote
WAVESHIELD 2000 GOLD for cellular (mobile) phones	$24.95	Quantity	Price Quote
WaveShield™ 3000 Series for cordless phones	$19.95	Quantity	Price Quote

Inquiry Date. Response Date.

ORDER INFORMATION: (Please complete all applicable information)

Name
Title
Company
Address
City	Zip Code.
State	Country
Area Code	Telephone number. FAX number
E - Mail Address
Web Site Address	(if available)

Please Print Completed Form And FAX It To:
FAX (949) 472-4908
Doctors' Marketing Service
P.O. Box 748, Lake Forest, California 92630-0748, USA
Phone (949) 472-3767; E. Mail: [email protected]

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		Use one Form per ORDER. To reduce "Banner", click on its "UPPER" right arrow.
		Type in the Form, on screen response, (fill out applicable blanks).
		Press "TAB" to move between blank spaces. When finished, please print the Form.
		Complete all blanks you wish to receive a price quote for quantity orders. Retail prices are listed below.
		Print completed Form and FAX it to DMS. Best time to send FAX is during the afternoon, after 2:00 PM (your time)