TOTAL FEE: Format of your web site $
+
No Of Changes X $10= $
PAYMENT:
USA Dollars, Checks only, no
credit cards.
Orders are Paid in full and in advance by checks drawn on American banks.
Check Number
(US Clients)
NONE
USA Clients: You may pay by wire, electronic transfer of funds
(details below).
On Line Tracking
Number (None US Clients)
Payment Date
Client Information:
First
Name
Middle
Name
Family Name
Specialty/Industry
Business Name
Address
City
State/Zip Code
Country
E-mail Address
Web Site Address
Sending The Order
Form
Please click on the method
used to send your payment: . .USA
Orders: Please complete, then print the Order Form and mail it with your
check to: Doctors' Marketing Service P.O. Box 748
, Lake Forest, California 92609-0748
Non-USA Orders: Electronic transfer of funds:
To avoid delays in processing your order
. To
send your payment online, kindly use the following account information: DOCTORS
MARKETING SERVICE Routing
Number: 122201198 Account
Number: 11072547 Farmers
And Merchants Bank 23772 Rockfield Boulevard, Lake Forest, California 92630, USA
Also,
please send the completed form on line, click on the button below. >>> Please Review The
completed Form before you click on "Send It in". <<< .
