Advertisement Form
.Laguna Beach Business Directory
Laguna Beach Business Directory For Cash Strong VIPs

How to Use This Form:
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. Type in the form, on screen response,  (fill out the blanks) and enter all applicable information
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Press TAB to move from one field to another
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If you make a mistake, erase/delete or Backspace and retype correct information
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Please click "Back" to return to this Order Form.
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Print Form and mail it with your payment to: Doctors Marketing Service address (shown below).
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Please enclose the following items:
u Completed Advertisement Form
u Payment (check only. No credit cards).


Order:
Enclosed is my check to list/advertise our company at the Laguna Beach Executives Business Directory listed at
28 Internet directories, national & international: (please, check one box)
 
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One Year Ad:  $125
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2 Years  Ad: $165
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3 Years  Ad: $185
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4 Years  Ad: $199

Deadline: October 14, 2005

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: (Please complete only applicable fields)
 
Name 
Title
Department 
Company
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 92609-0748
 

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