Contact & Credit Card Information

Contact Information :::

Doctor ID:
Office Name:
Contact Name:
Contact Phone:
Contact Email:
**Payment Information :::
Name on Card:
Type:

Card Number:
Expires:	(mmyy) Security Code:
Billing Address:
Billing City, State Zip:	,

Sponsor Listings :::	Check Box Below to Upgrade Your Account to 'Feature Doctor'
Sponsor Listings:	You are going to buy featured doctor and coupon positions on: http://www.doctorscoupons.com. New Account Special! The cost is ~~$249.00~~ $99 per month. You agree to the Doctors Coupons Advertisement Agreement and Policy. Sponsor listings will be placed on the first page for your specialty in your area. See sample sponsor listings preview. Feature Doctor Program includes: 1. Top of the page business listings and coupon ad* in your area 2. Instant e-mail alerts on coupon downloads 3. Access to user's contact info* 4. Exclusive access to new features and marketing tools 5. Dedicated account manager assistant 6. Instant coupon management Semi-annual payment required with 6 months of service. Total Cost $594.00* (Total savings of $900!!). Within 20-30 miles of user's zip code. *User's that download your coupons.
Promo Code:

** A credit card is required for office verification and for your coupon listings to be active, but it will not be charged now. Our staff will contact you once your listing is approved before a transaction is processed.

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