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). 
Press "TAB" to move between blank spaces. 
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
Business Name:
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:

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 #
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

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