Mailing Lists - Order Form

^{PROFESSIONAL
LISTS}
ORDER FORM

How to Use This Form:

Type in the form, on screen response, (fill out the blanks) and enter all applicable information
Press TAB to move from one field to another
If you make a mistake, erase/delete and retype correct information
Click on underlined titles to view list information. Please click "Back" to return to this list.
Print Form and mail it with your payment to: Doctors Marketing Service address (shown below)

Please enclose the following items:

Completed Order Form

Payment (check only. No credit cards).

Orders from outside the USA, please send a Money Order in your country's currency.

FEES:

L I S T

PRICE

.........................

Group Lists At Discounted Prices:
.

Group List A: $295

Group List B: $399

Group List C: $195

USA Chiropractors List (.5¢ /Record)	$100	...................
		..................
USA Orthopedic Surgeons List(3¢ /Record)	$345	..................
		..................
USA Physical Therapists List (1.5¢ /Record)	$750

USA Pharmacies List(1.5¢ /Record)	$1,050	..................
		..................
USA Hospitals List(1.5¢ /Record)	$1087.5	..................
		..................
USA Animal Hospitals & Vet Clinics List (1.5¢ /Record)	$525	..................
		..................
USA Fitness Clubs List:		..................
Names & addresses only: (2¢ /Record)	$199	..................
Names & addresses plus phone numbers (2.5¢ /Record)	$249	..................
		..................
USA Women Only Fitness Clubs List		..................
Names & addresses only: $79 (8¢ /Record)	$79	..................
Names & addresses plus phone numbers: (10¢ /Record)	$99	..................
		..................
USA Professional Athletic Teams List(89¢ /Record)	$89	..................
		..................
World Beauty & Cosmetics Distributors' List (60¢ /Record)	$75

World Health Distributors List (about 17.5¢ /Record)	$35

Total Order:
To avoid any delays in processing your order, kindly double check all selected categories and enter appropriate rates.

Total Amount Paid: $	Check #
Mailing Date:

COMMENTS:

ORDER INFORMATION:

Name
Title
Department
Institution
Address
City	State/Zip Code:
Country
Area Code	Telephone number: FAX number:
E.Mail Address
URL (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

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