Advertisement Form

Advertisement Form
Arab American Seniors Directory

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.

Advertisement Fees:
Space at home page advertisement is limited and offered on on first come, first serve basis. .

	Home Page, Banner Advertisement: 1 X 3 Inches (Placed at top of Home page) Special Fee: $395/year (Regular Fee: $895/year)	Home Page, Listing/Link Advertisement: Special Fee: $195/year (Regular Fee: $495/year)
.
	Category Advertisement/Listing: Special Fee: $85/year (Regular Fee: $295/year)	Web Card Advertisement: Sample Special Fee: $35/year (Regular Fee: $95/year)
.
	Arabic Web Page Design: Sample1 , Sample2 Special Fee: $95/year (Regular Fee: $165/year) English language Text (Up to 100 Words) Pictures (up to 3 photos 2 X 4"). Larger pictures are re-sized

Total Amount Paid $.

Check Number.

Payment Date.

ORDER INFORMATION: (Please complete only applicable information)

Name	.Title
Specialty
Department
Institution
Address
City	.State/Zip Code ..Country
Area Code	Telephone number ..FAX number
E - Mail Address
Web Site Address

Please Print Completed Form And Mail It With Your Payment To:
Doctors' Marketing Service
P.O. Box 748, Lake Forest, California 92609-0748, USA

Click Back To Home Page

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.