Order Form

Please use the form below to place your order for each of your office staff to include the referral coordinator, billing clerk, medical records coordinator, transcriptionist, receptionist, director of nursing, office manager, and administrator. And, don't forget your marketing staff, sales reps, and public relations coordinators!

This new full-sized, comprehensive, one volume directory of physicians and health care providers will be one of the most valuable assets your business will use on a daily basis. You will save time and money by having every BCMS member at your fingertips, plus all other San Antonio / Hill Country physicians and health care providers.
 
 

Please provide the following information:

Full Name
Title
Organization
Work Phone
FAX
E-mail

Please provide the following ordering information:

Quantity
Requested		 No. of
Copies		 San Antonio
Unit Price		 Extended
Total

1-5

$75

$

6-10

$70

$

11+

$65

$
Less 10% for BCMS Physician Members

$

Add 8.125% Sales Tax

$

Total

$


BILLING

Credit card

Cardholder name

Card number

Expiration date
   
SHIPPING
Street address
Address (cont.)
City
State/Province
Zip/Postal code
   
 
   
     
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