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 check to: Doctors Marketing Service address (shown below)
Orders are paid in full and in advance.
Partial lists are not available for sale

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.

L I S T
For list information, please click on underlined titles (linked)

Special
PRICE

Additional Information

..	Women Executives/Professionals List Number of Records = 6,000 List Contents: Every record contain the following information: u Full name, mailing address, phone & Fax numbers and E. Mail address. u Special Price: 5¢ /Record Regular Price: 9¢/Record	..	$300	..	Deadline Special Price June 16, 2006 ....
		..		..
.	Executives/Professionals List: Men & Women Number of Records = 12,000 List Contents: Every record contain the following information: u Full name, business name, mailing address, phone & Fax numbers and E. Mail address. u Special Price: 5¢ /Record Regular Price: 9¢/Record	..	$600	..	Deadline Special Price June 19, 2006
		.		..
	USA Chiropractors Mailing List	..	$100	..	0.5¢ /Record 20,000 Records
		..		..
	USA Orthotic/Prosthetic Practitioners List	.	$1,100	.	20¢ /Record 5,500 Records
		.		.
	USA Orthopedic Surgeons List	..	$345	..	3¢ /Record 11,500 records
		..		..
	USA Physical Therapists List	..	$750	..	1.5¢ /Record 30,000 records
		..		..
	USA Pharmacies List	..	$1,050	..	1.5¢ /Record 70,000 records
		..		..
	USA Hospitals List	..	$1087.5	..	1.5¢ /Record 72,500 records
		..		..
	USA Animal Hospitals & Vet Clinics List	..	$525	..	1.5¢ /Record 35,000 records
		..		..
	USA Fitness Clubs List	..	190	..	2¢ /Record 9,500 records
		..		..
	USA Women Only Fitness Clubs List		120	..	13¢ /Record 900 Records
		..		..
	USA Professional Athletic Teams List	..	$89	..	89¢ /Record 100 records
		..		..
	World Health Distributors List	..	$78	..	39¢ /Record 200 records

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 Check To:

Doctors' Marketing Service
P.O. Box 748
Lake Forest, California 92609-0748, USA

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