Web Site Design - Order Form

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Site Design - Order Form}

How to Use This Form:

n . Type in the form, on screen response, (fill out the blanks) and enter all applicable information

n Press TAB to move from one field to another

n If you make a mistake, erase/delete or Backspace and retype correct information

n While completing this form, DO NOT click "Back". If you do, all entered information will be erased upon your return to this form.

n Print Form and mail it with your payment to: Doctors Marketing Service address (shown below).

.

n Please enclose the following items:
u Completed Order Form + Payment (check only. No credit cards).
u Orders from outside the USA, contact DMS: cidms@yahoo.com

Order: (To place your order, click and type in selected boxes)
.

	Special Offers and Group Rate (See DMS announcements for details): Type of web site: Standard Sponsored Other (please give name) Number of web pages X Fee per web page $ = $

	Independent Web Site Design: $299 per web site (for details, click here)

	Executive Web Site Design: $575 per web site (for details, click here)

n	.Additional Photos: $15/each: .No. Photos X $15 = $ .Add Captions under Photos ($10/Photo) .No. Captions. X $10 = $ Assign the captions numbers which correspond to specific photos. Also, limit your captions to about 5 words.

	Form Design: Additional Forms .E. Mail Forms (sample): $85/ea .Regular Mail Forms (sample) : $55/ea

	Add Music To A Web Site (sample): $25/Musical Piece .No. Musical Pieces X $25 = $ Client will supply the musical piece(s) in MIDI format, sent to DMS by E.MAIL.

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

Total Amount Paid: $	Check #
Mailing Date:

COMMENTS/Brief Instructions (optional):

ORDER INFORMATION: (Please complete only applicable fields)

Name
Title
Department
Institution
Address
City	.State/Zip Code
Country
Area Code	.Telephone number FAX number
E.Mail Address
.web site address (optional)

>>> Please Print Completed Form And Mail It With Your Payment To:
Doctors' Marketing Service
P.O. Box 748, Lake Forest, California 92609-0748, USA
Back To HOME PAGE

n	.	Type in the form, on screen response, (fill out the blanks) and enter all applicable information
n		Press TAB to move from one field to another
n		If you make a mistake, erase/delete or Backspace and retype correct information
n		While completing this form, DO NOT click "Back". If you do, all entered information will be erased upon your return to this form.
n		Print Form and mail it with your payment to: Doctors Marketing Service address (shown below).
.
n		Please enclose the following items: u Completed Order Form + Payment (check only. No credit cards). u Orders from outside the USA, contact DMS: cidms@yahoo.com