Back Talk Systems Inc. - Postcard Order Form

Postcard Order Form

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

All postcards cards are customized with your practice information. Back Talk Systems uses this form to collect all information needed to customize your postcard 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: Postcards and Quantity

Braces Postcard:			Postcard prices are based on the total number of postcards you purchase. 100 @ .29 each = $29.00 200 @ .26 each = $52.00 300 @ .24 each = $72.00 400 @ .22 each = $88.00 500+ @ .19 each = $95.00
Dentures Postcard:
Eye Exam Postcard:
Jet Engine Postcard:
Living Proof Postcard:
Miss You Postcard:
Patched Postcard:
Phone Postcard:
Safe Postcard:
Trust Postcard:
What You See Postcard:

Section 6: Notes

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