Back Talk Systems Inc. - Calendar Card Order Form

Calendar Card Order Form

Please use this form to order Calendar Cards. After submitting this form one of our customer service representatives will call you to collect payment for your order.

All calendar cards are customized with your practice information. Back Talk Systems uses this form to collect all information needed to customize your calendar cards.

If you do not wish to include information from one of the requested fields, please leave it blank.

Section 1: Proofing Information

	Contact Name:
	Fax Number:
	Email:

Section 2: Customization Information

	Clinic Name:
	Doctor Name:
	Address 1:
	Address 2:
	City:
	State:
	Zip Code:
	Phone Number:
	Website:

Section 3: Fonts

Section 4: Calendars and Quantity

Apples Calendar:			Calendar prices are based on the total number of calendars you purchase. 100 @ .59 each = $59.00 200 @ .44 each = $88.00 300 @ .39 each = $117.00 400 @ .34 each = $136.00 500 @ .30 each = $150.00 600 @ .29 each = $174.00 700 @ .28 each = $196.00 800 @ .27 each = $216.00 900 @ .27 each = $243.00 1000+ @ .26 each = $260.00+
Butterfly Calendar:
Eagle Calendar:
Hummingbird Calendar:
Ladybug Calendar:
Penguin Calendar:
Pets Calendar:
Rock Climber Calendar:
Edison Sunset Calendar:
Trees Calendar:
Waterfall Calendar:

Section 5: Notes

Please include any notes that would help us finish your order to your satisfaction: