BMN Press Release Order Page -- www.biomedical-market-news.com/orderpg.html

Welcome Visitors or Clients:
To schedule your announcement(s) or Tradeshow E-Notice™, complete this form, print, and fax to our 24/7 SecureFax™ line: +1 (714) 549-4266
At the same time e-mail your release to our editorial dept at: releases[at]biomedicalnews.org
One of our staff will call or email you within 24 business hrs to confirm your order and schedule your press release
(requests over weekend will be responded to Monday); please allow 24-48 hrs lead time before your announce date; dates based on availability
Any questions? Call us at +1 714 549-4180 (9:00am to 5:00pm Monday through Friday, PST)

Section A --- Your Contact Information

Section C --- Payment Method

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

◄   Name
◄   Job Title
◄   Company / Organization
◄   Company or Mail Address-Line1
◄   Company or Mail Address-Line2 ◄ Your Phone Number     ◄ Your Fax Number             ◄   Your Email Address

How did you hear of us? (optional)

Section B --- Your Service Order Request

Please select your Press Release or Tradeshow E-Notice™ option:

QTY COST: PRODUCT DESCRIPTION (New Client Pricing Only)

1   $ 499.00   1-Single Press Release or Tradeshow E-Notice™

1   $ 949.00 2-Set Pack, advised for repeat messaging

1    $ 1,299.00 3-Set Pack, best plan -- most impressions to market

Received another offer? --enter your promo code in Section D, Payment Due Box
                                              --enter your promo price in Sub-Total Window

   ABOVE PACKAGES INCLUDE:
   ● E-Optimize™ -- Copy optimization, deliverability optimization, link checks
    ● Dynamic URLs directing respondents to your web pagesp
    ● ViewTrack™ Report (available on certain orders only -- fee may apply)

COMPLETE THIS SECTION BELOW (TO HELP US SCHEDULE YOUR ORDER):
Enter a job reference name or press release title for up to 3 press releases.
If purchasing a multipack for the same release just enter a job name once under Job Name #1.
Enter your projected date(s) you want your release(s) distributed.

< JOB NAME #1
< JOB NAME #2 < JOB NAME #3

< PREFERRED SEND DATE - JOB 1 (enter as 00/00/2011)
< OPTIONAL SEND DATE    - JOB 1 ( in case 1st date is booked)

< PREFERRED SEND DATE - JOB 2
< OPTIONAL SEND DATE    - JOB 2

< PREFERRED SEND DATE - JOB 3
< OPTIONAL SEND DATE    - JOB 3

All release send dates may be modified due to slot availability and will be confirmed by your rep.

Select Your Card - Then complete all lines below:
AMERICAN EXPRESS	VISA
MASTERCARD	DISCOVER

◄ Cardholder Name ◄ Credit Card Number
◄ Billing Address - Line1 ◄ Billing Address - Line2 ◄ Credit Card Exp Date ◄ Signature (type in)
//

Section D --- Payment Due

Add Your Cost/Service Option From Section "B"

SUB-TOTAL (enter $499.00; $695.00, $999.00, etc)

Promo Code (if any):

Extra Services (Campaign Banners, ViewTrack™)

(Calif. billing addresses / clients add 8.75% tax)

◄ TOTAL (add your total here)

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

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

NOTE: Your Printer May Not Display/Print this form correctly based on your printer settings; the printout is acceptable as long as the answer windows are visible.

SCHEDULING AND TERMS:
24 to 48 hrs lead time before your send date is required.
Transmit Dates Based on Availability.
Receipts: You will receive an e-receipt of your order (receipts do not contain credit card data) to your email address. Allow 24 hrs.

Payment: As setup and editing time/labor are allocated to releases before sign-off, pre-payment is required on orders before transmission date.

IF PAYING BY CHECK:

If paying by check or money order, remit this order w/your payment payable here:

Checks/MOs must be received (5) business days prior to transmit date.
You will receive a payment confirmation by email.