cdromorderform

CD-ROM Order Form

How to use this Form:

Use one Form per practice. 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 (Banner will not print with Form): Set your printer to print only one page/black ink.

Preferred payment: Check drawn on an American bank.

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

Your Order and Fees:

		Number of Photos X $12 per Photo = $
		Number of Photo Blocks X $5 per Block = $
		CD-ROM Index Development: $45
		Number of web pages to be copied from your web site X $35/web page = $
		Number of CD-ROM Disk copies: CD-ROM Disks X $5 per Disk = $
		TOTAL: $ Date Check Number

ORDER INFORMATION: (Please complete only applicable information)

Name	Title
Special Interest
Department
Institution
Address
City	State/Zip Code Country
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

Click Back To Home Page

Hosted by www.Geocities.ws

		Use one Form per practice. 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 (Banner will not print with Form): Set your printer to print only one page/black ink.
		Preferred payment: Check drawn on an American bank.
		Acceptable payment: International Money Order by using your country's currency. Our bank will send the Money Order back to country of origin for collection. The process usually takes about 3-4 weeks.