MasterPlan Alliance Online
A division of Du Molin & Du Molin, Inc.
Support Tools Order Form
You may order electronically by submitting the following form.  Alternatively you may order by calling toll-free 1-800-795-2946 or by printing this form and faxing it to 415-435-2723.

Please provide the following ordering information:

Select the Alliance support tools you need to achieve the success you deserve.  Check box of product you wish to order. All support tools come with an unconditional 30 day money back guarantee.    An " * " indicates required Information.
The Doctor's Master Employee Policy System -         Hard Copy & Computer Disk --  $189
The Doctor's Master Employee Policy System -         Hard Copy & Computer Disk & Professional         Review --  $579 Highly Recommended
BILL TO:
First Name*
Last Name*	D.D.S. D.M.D. Mr. Mrs. Ms.
Card Type*	VISA MasterCard American Express
Card Number* Expir. Date*	Example: 03/99
SHIP TO:
Street Address*
Address (cont.)
City*
State/Province*
Zip/Postal Code*
Country
Office Phone*
FAX Number
Home Phone
Email Address*
If you would you like to receive our monthly E-Mail update        on the latest articles and Alliance events, check the box.
SHIPPING METHOD:
Standard UPS	You can expect delivery within 5 business days
2 Day UPS	If your order is placed before noon - 2 day delivery
Over Night UPS	If your order is placed before noon - next day
If you are a California resident 7.25% sales tax will be added to your order