The Medical Letter®
On Drugs and Therapeutics

Order Form 

Please print the empty form and complete it by hand.  You may fax, send by postal mail, or call in your order.  Make checks payable to The Medical Letter. Call to check on shipping costs.

Mail:
The Medical Letter
1000 Main Street
New Rochelle, NY   10801-7537
Fax:
(914) 632-1733

Phone:
(800) 211-2769
(914) 235-0500

Item Quantity Price Sub-Total
       
       
       
       
       
       
Are you a subscriber to The Medical Letter?

shipping: 

 
Yes, subscription number: ___________________________

Total: 

 
Delivery Information:
Company Name: ________________________________   Title (Dr., Mr., Ms.):  _________
First Name: ____________________   Last Name:  _________________________
Street Address 1: ___________________________________
Street Address 2: ___________________________________
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Zip Code: _______________________   Country: ____________________
E-mail address: _________________________
Phone Number: _____  _____________    Extension: _______
If you are a student, resident, intern or fellow, please list your affiliation:________________________
If you are ordering a subscription, please indicate the month you would like to start: _______________

Credit Card Information:

Card Type (VISA, Mastercard, American Express): __________________
Credit Card Number: _______________________   Billing Address Zipcode: __________
Expiration Date:  month ________  year   ________
Cardholder Name:  ______________________________________
Signature:  ___________________________________