Web Site Design - International 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).

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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)
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	Special Offers and Group Rate (See DMS announcements for details):

	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 Complete This Form And Click On Send it In.
Once we receive this completed Form, we will send you Our Bank Account information by E. Mail
Your Payment should be sent by Electronic Transfer Of Funds to our bank.
Doctors' Marketing Service
P.O. Box 748, Lake Forest, California 92609-0748, USA

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To send the completed form on line, click on the button below.
>>> Please Review The completed Form before you click on "Send It in". <<<
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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