intlorderform

Order Form:

Development of Informational Web Pages Network

How to use this Form:

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

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

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

Send with your payment a list of informational web pages ' titles or "keywords".

You may pay for development of additional informational web pages at their discounted rates. Titles of future web pages may be sent by E.Mail.

Preferred payment: Check drawn on an American bank.

Acceptable payment: International Money Order or a check drawn on a local bank by using your country's currency.
Our bank will send the check back to country of origin for collection. The process usually takes about 3-4 weeks.

FEES:
Listed are the discounted fees which are about 50% discounted from their regular fees. You may wish to take advantage of the discounted fees by ordering larger number of informational web pages. The offer of discounted fees may be terminated without notice.

Number of Informational Web Pages ($______/each): FEE:$______ XWeb Pages = $

Number of Search Engines you wish DMS to register above web pages. FEE: $5 XNo. Search Engines = $

TOTAL Fee: Add amounts from selected boxes above and enter here $
Date. Check Number.

ORDER INFORMATION: (Please complete only applicable information)

Name	.Title
Special Interest
Department
Institution
Address
City	.State/Postal Code ..Country
Country Code	.City/Area Code. Telephone number ..FAX number
E - Mail Address
Web Site Address

Please Print Completed Form And Mail It With Your Payment To:
Doctors' Marketing Service
P.O. Box 748, Lake Forest, California 92630-0748, USA
(949) 472-3767

Hosted by www.Geocities.ws

		Use one Form per practice/organization. To reduce "Banner", click on its "UPPER" right arrow.
		Type in the Form, on screen response, (fill out all applicable blanks).
		Press "TAB" to move between blank spaces. When finished, please print the Form.
		Send with your payment a list of informational web pages ' titles or "keywords".
		You may pay for development of additional informational web pages at their discounted rates. Titles of future web pages may be sent by E.Mail.
		Preferred payment: Check drawn on an American bank.
		Acceptable payment: International Money Order or a check drawn on a local bank by using your country's currency. Our bank will send the check back to country of origin for collection. The process usually takes about 3-4 weeks.

	Number of Informational Web Pages ($______/each): FEE:$______ XWeb Pages = $
	Number of Search Engines you wish DMS to register above web pages. FEE: $5 XNo. Search Engines = $