Order Form - Arab Women Doctors Directory
دليل الطبيبات العرب

 How to use this Form:
n Use one Form per doctor
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:
Clinic/Organization Name:

I would like to order building my  web site and listing at Arab Women Doctors Directory :
.Languages: English .Arabic .Arabic + English Languages
u Please click on Sample. You may send your CV or your clinic information or both.
Fee: $195
.Additional pages (text) or pictures: Please add $25/each
 TOTAL FEE:  ( No. additional pages (text )  +  No. additional pictures. X $25)  + $195 = $

Web Site Specifications:
Text: Up to 3 pages. Page Size: 8½ X 11". Pictures: Up to 5 pictures. Size: Up to 2 X 4".
All material (text & pictures) should be sent as attachments by E. Mail: cidms@yahoo.com

PAYMENT:
Orders are paid in advance US dollars. Regarding USA orders, they are paid by check and mailed as shown below.
Orders from outside the USA, are paid in advance by electronic transfer of funds. Kindly, contact DMS by E. Mail to send you the needed bank information.
Date your payment was sent/mailed 
Your check Number or your Tracking # (Electronic Transfer Of Funds - Orders outside USA) 
Your Address And Contact Information: 
Number  Street and  Suite #
City
State/ Zip Code
Country Code (USA, leave blank) . Area Code.
Telephone Number
FAX Number 
E-mail Address
Web Site Address (if available)
Sending The Order Form

Please click on the method used to send your payment:
.
.USA Orders: 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

  Outside USA Orders: Electronic transfer of funds: To avoid delays in processing your order
.
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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