Type in the Form, on
screen response, (complete applicable blanks).
Press "TAB" to move between
blank spaces.
DO NOT press the "BACK"
button because all information will be deleted if you leave this web page.
YOUR ORDER: I would like to order a
list in a Word program about Women Teen Cases. Please click on
SampleFee: $10/Case. Total fee is
$2,000 for 200 cases.
PAYMENT:
On Line: At
your bank website, please go to "Send Money With
Zelle".
Also, click here for info about
Zelle Payment Date
Name And Contact Information:
First
Name
M.I.
Last
Name
Title
Business Name
Number & Street
Suite #
City
State
Zip Code
Area Code
Telephone
FAX
E-mail Address
Web Site URL
. >>> Please Review The
completed Form before you click on "Send It in". <<< .
Doctors' Marketing Service P.O. Box 748
, Lake Forest, California 92609-0748
