Call: 866.272.3799

Order Form: Health Care Monthly Mail Program

Order using the form below or download, print, and fax back the PDF order form.

**We will contact you to discuss your projects before design work begins and before your credit card is charged.

Terms (Initial below):

Brazzell Marketing Agency, Inc. (BMA) agrees to:
  • To design a new flyer every month.
  • To develop a mail list with the assistance of the customer.
  • To make all necessary deletions and additions to the mail list on a monthly basis.
  • To provide all envelopes, paper, printing and postage necessary for 8.5”x11” flyers in #10 envelopes.
  • To refrain from mailing until approval for the piece is received.
  • To mail up to the selected "Mailer Level" each month. “Pieces” means one flyer in one envelope.
Choose your Mailer Level:
We recommend 300 for the average size agency or practice.

Authorized E-Signature:

Your Contact Information

Company Name:

Contact Person:

Phone Numbers:

Contact Emails:

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Credit Card Number (AmEx, Visa, MasterCard):
Expire Month:    Expire Year:
Name on Card:

Billing Address for Card:
State:    Zip: