10orderform

Order Form: CI-DMS Internet Directories
Attract Patient Referrals To Your Practice

How to use this Form:

Use one Form per practice. All fees are listed on a "PER YEAR" rate. 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.

Orders are paid in advance. Check only. 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: (please type x in appropriate boxes)

Arab Neurosurgery Directory	Special Fee $85	Reg. $465	Arabic Web Page Development:
Arab Health Directory	Special Fee $55	Reg. $375	Special Fee: $189/web Page. Reg. Fee: $325
World Specialists Directory	Special Fee $40	Reg. $250	Describe your professional skills/services in Arabic
Arab Family Web Site/Directory	Special Fee $35	Reg. $185
International Patients Programs	Special Fee $25	Reg. $145	Web site Design: Contact DMS

Multi-Directory Discount: Listing/web Site Link in All Five Directories: $135, Deadline: Nov. 30, 2001
TOTAL (Please add all checked boxes above): $ 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

		Use one Form per practice. All fees are listed on a "PER YEAR" rate. 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.
		Orders are paid in advance. Check only. 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.