Advertisement FORM
Attorneys For Physicians

 How to use this Form:
n Use one Form per Order.
n Type in the Form, on screen response, (complete applicable blanks). 
n
Press "TAB" to move between blank spaces. 
n
DO NOT CLICK ON "ENTER" while completing the form. If you do that, you will close the form and send incomplete Form!
n DO NOT press the  "BACK" button because all information will be deleted if you leave this web page.


Contact  Name:
First Name
Middle Name
Last Name
Title:
Business Name:
 
ORDER:
Advertisement for multiple years guarantee your current fee and no future increase in rates for selected years.
 
I.  Attorneys - Advertisement/listing at the web site “Attorneys For Physicians”:
     
       .Banner Advertisement: $975/yr                             Years:    Amount Paid $
              Available space up to 4 banners at top of the web site which include the following:
              Photo + + Description of key services (up to 50 words) + Link to main web site
 
       .Display Advertisement: $285/yr                            Years:    Amount Paid $
             Included a photo + Description of key services (up to 50 words) + Link to main web site
      
.Listing: $95/yr                                                       Years:    Amount Paid $
             Included Name + Link to main web site

II.  Sponsors:

       Categories:
web site link service is included for both categories
       .Executive: $265/yr                                              Years:    Amount Paid $
             Top of the list prominent position.
       .Regular: $98/yr                                                   Years:    Amount Paid $
             Appear after the executive listing category.

Amount Paid $     Check Number            Date Paid 


Address And Contact Information: 
Number  Street  Suite #
City
State/ Zip Code
Telephone Number
FAX Number 
E-mail Address
Web Site Address (if available)

Sending The Order Form

Please complete, then print the Order Form and mail it with your check to:

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

Back To Home Page

E. Mail