Medical Industry Data Products Order Page

Welcome Visitor:
Should you like to order any of our directories or lists offline (or should online shopping cart be unavailable), find your
data product below, complete this form, print, and fax to our 24/7 SecureFax™ line: 1 (714) 549-4266
One of our staff will email you within 24 business hrs to confirm your order. Products are emailed within 24 -48 hrs after payment is processed.
(Requests over weekend or holidays will be responded to on Monday or first available business day after holiday)
Have questions? Call us at: 1 (714) 549-4180 (9:00am to 5:30pm Los Angeles | California | USA time)
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Section A -- Your Contact Information

Please [type-in] all lines so we can reach you to confirm your order.

◄ Your Name ◄ Position Title
◄ Company / Organization ◄ Company or Mail Address-line 1 ◄ Company or Mail Address-line 2 ◄ Your Phone Number ◄ Your Fax Number ◄ Your Email Address

Section B -- Your Product Order Request

   Please select your product below by marking box to left of item:

       QTY       COST:    PRODUCT DESCRIPTION (Click on product for details)

1   $ 349.00 Top 500 Medical Product Companies™ -- Orange County CA
                             2009 Edition

1   $ 499.00 Top 500 Medical Product Companies™ Plus Doctors
                             & Service Providers™ Orange County, CA -- 2009 Edition

1    $ 99.00 Medical Industry Directory of MDs & Service Providers™
                     Orange County, CA -- 2009 Edition

1 . $ . 49.00 Medical Industry Search Firms & Recruiters™ USA 2009 Ed

1   $ . 59.00 Medical Industry Conference Calendar™ Yrs 2009-2010
                             Worldwide Edition

1 $ 199.00 Top 500 Cardiology Companies™ Global 2009 Edition

1   $ 99.00 Cardiologist Mailing List™ National 2009 Edition

1   $ 199.00 Plastic Surgeon Mailing List™ National 2009 Edition

1   $ 99.00 Biomedical Market Newsletter ™ -- Newsletter Issues
                         << Enter Volume & Issue #
                            Sample: Volume 19, Issue1

Section C -- Payment Method

Select Your Card - Then complete all lines below
For payments via check or money order see bottom portion of this form

AMERICAN EXPRESS

MASTERCARD

VISA CARD

DISCOVER

◄ Name of Card Holder ◄ Credit Card Number ◄ Card Billing Address-line 1 ◄ Card Billing Address-line 2 ◄ Credit Card Exp Date ◄ Signature -Type In

PAYMENT DUE:
Add Your Cost/Service Option From Section "B":

SUB-TOTAL (enter $349.00; $499.00, $299.00, etc)

Promo Code (if any):

Tax (Calif. billing addresses/clients, add 8.75%)

◄ TOTAL (add your total here)

If all fields are correct, your card will be charged the amount in 'TOTAL' Box.

Finished? ... Print This Form and Submit To:
Our 24/7 SecureFax™ Line: 1+ (714) 549-4266

Note: Your printer settings may not display full form
correctly; printout is acceptable as long as all answer
windows and answers are visible. Thank You.

You will receive an e- receipt of your order to your email address and
the product will be sent to the email address provided on this form.

If paying by check/money order, remit this order w/ payment and mail here:

You will receive an e-confirmation once your check has been received and
your product will be e-mailed after payment is processed.