Fill in the form and click SEND button,
or print it and fax to
(972) 393-8699.

For payment
by check:
Print the form and
mail it with the check
payable to
Global MedNet, Inc.
3521 Oak Lawn Avenue
PMB 614
Dallas, TX 75219, USA


To the DO Club

CD ORDER FORM
CD Order Form

ON-LINE ORDER
First Name:
Last Name:
Specialty:
Address:
City:
State/Province:        Postal Code:
Country:
Telephone:
Fax:
Email:
Price: US $ 199.00
Quantity:   (enter quantity)
Subtotal:
Texas residents: add 8.25% sales tax
Total:
PAYMENT TYPE:
Check or Money Order
Bill Credit Card at Shipment *
 Master Card     VISA     AMEX
Name on the Card: 
Card #: 
Exp. Date: 
* CD-ROM will be shipped in 7-10 business days. If you have selected credit card payment, your credit card will not be billed until shipment of the CD.
For any additional information send e-mail to do-cd@globalmednet.com