Order Minnesota MedFAX

Order
Minnesota
MedFAX

To order, please call
(612) 728-8600
or print this page
and mail or fax
this form to:

Minnesota Physician Publishing, Inc.
2812 East 26th Street,
Mpls., MN 55406
Phone: (612) 728-8600
Fax: (612) 728-8601

Check one: 26 Weeks $143 51 Weeks $255 76 Weeks $332

Name/Title:

Company:

Address:

City, State, Zip:

Phone/Fax:

Check Enclosed Bill Me Visa MasterCard Card# Exp. Date:

(You can also order by clicking on the "Order" button below, but if you're paying by credit card,
leave the "Card#" and "Exp. Date" fields blank. We don't recommend transmitting your credit card
information over the Internet. Submit your order and call us with the card information.)

Name/Title:
Company:
Address:
City, State, Zip:
Phone/Fax:
Check Enclosed Bill Me Visa MasterCard Card# Exp. Date: