Insertion Order
Salutation MR MRS MS DR
First Name  
Last Name  
Title  
Company  
Department  
Address  
City  
State/Province  
Country  
Zip  
Phone  
Fax  
Email  
Specifications  
Issue Date  
Ad Size  
Color  
Cover  
Ad Caption  
Requests  
Production Info  
Art Enclosed  
Arrival Date  
Production Requests  
Frequency  
Gross Cost  
Agency Fee  
Net Cost  
Authorization  
Date  
Accepted By  
Date  
Profession  

Payment Options
Payment by Checks (US funds only)
Make Checks Payable to
International Medical Devices
166 South Industrial
Saline, Mi 48176
Phone 734-944-5850

Payment by Fax
Print this page and fax to
International Medical Devices
Fax 734-944-5840

Card Type  
Card Number  
Name on Card  
Expiration Date  
     
 
   

 

 
 
 
 
© Copyright 2006 International Medical Devices Magazine