Order Form
For Specialists Who Like To Provide Services To Arab Cash Patients

How to use this Form:

Use one Form per Order.
Type in the Form, on screen response, (fill out all applicable blanks. For others , please type "NA" not applicable)
If you make a mistake, backspace and type again, or highlight the entire box and hit "Backspace".
Press "TAB" to move between blank spaces.

I would like to order the following service;
Design a new Arabic website to describe the client's skills and procedures. Also, the new website will receive a free website hosting value $83 per year):  Sample 1
    Sample 2      Sample 3

List the client's new Arabic website and clinic at the following Arab websites:

  1. Face Cosmetic Procedures - Arabic Language Samples

  2. Directory Of Top Specialists For Treating Arab Cash Patients

  3. Arab Women Doctors Network

NOTE:
DMS will complete the entire job with no burden on the client or on the staff. Also, the client's website is used as a reference to perform above services. Moreover, all listed websites are owned and managed by DMS.

Fee :
$195
(one time, special fee). Reg. Fee: $250

PAYMENT:

  • Made in full and in advance, checks, no credit cards.
  • Check Number  
  • Payment Date   

Contact Information:
 
First Name   Middle Initials   Family Name
Title
Business Name
Address   City   
Country Info State/Zip Code 
E-mail Address   
Web Site Address

Sending The Order Form .

Please complete the form on line, then print and mail it with your check to:
Doctors' Marketing Service
P.O. Box 748 , Lake Forest, California 92609-0748
 
E. Mail: affluentpatients@gmail.com

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