This is a One-Time Offer for E-REHAB Brochures
Fill out this form completely to have your brochures customized.
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Email *
Your Name *
Your Cell Phone Number (we will call this number for payment. Please have this ready) *
Your Practice Name as you want it printed on your brochures. *
Your web address as you want it printed on your brochures. *
Address, Phone, and Fax Number Area
Addresses, phone, and fax numbers to be printed on the back middle of the brochures.  Do not include any additional info here. *
Your competitive differentiators can be added to the back middle.
List your unique properties, competitive advantages, special features of your practice.  These will be printed on the back middle of the brochures.  INCLUDE ONE PER LINE *
Check the brochure condition types you want below ($35/each) *
Required
Once you submit your form, we will contact you for credit card information.  It's $35/brochure.  You are responsible for proofing the brochures, sending feedback to the designer, uploading them to the printing service of your choice, and paying for printing.  E-rehab and the graphic designer are not responsible for errors.  Proofread them before you get them printed. *
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