Advertisement Order Form

DMS Internet Directories & Web Sites

How to use this Form:
n Use one Form per order. Type in the Form, on screen response, (fill out all applicable blanks). 
n Press "TAB" to move between blank spaces. When finished, please print the Form. 
n Payment: Check only, no credit cards.

.Order a listing/Web Site Link in any Internet 
Group of Directories For One LOW Fee: contact DMS
Directories & Web Sites
#
Directory
Per Yr
1
Adv. Phys Med. Rehab Dir.
$175
2
OC Women Groups Dir.
$35
3
Clinical Trials Registry
$95
4
Medical Laboratory Directory
$25
5
Obstetrics & Gynecology
Southern California Directory
$95
6
O. C. Care Providers Directory
$195
7
O.C. Businesses Directory
$75
8
O.C. Mental Disorders
$45
9
Women Doctors Directory
$125
10
Workers Compensation Dir.
98
11
Recommended Specialists
$75
12
2nd Opinion Specialists Dir.
$85
13
Home Professionals Network 
$55
14
Laguna Woods Today
$75
15
O.C. Beauty & Health
$35
Web Site Maintenance Fee: $20/Month
1 year, minimum Order = $240
Monthly update/changes  not to exceed 
20% of the web site
Additional Instructions: (Optional)

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 .Please mark (X) appropriate boxes:
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..Special Advertisement Fee (Contact DMS)

...Brief Description of Ordered Service: 
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.....Amount Paid $.
     Deadline (Payment received at DMS) .

TOTAL FEES
Add amounts from selected boxes above and enter here $ 
Date. 
Check Number. 

  ORDER INFORMATION: (Please complete only applicable information)
.. Name .
Title
Special Interest
Department
Institution
Address
City
State/Postal Code ..
Area Code .
Telephone number .FAX number 
E - Mail Address
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