back

The Medical Letter®
On Drugs and Therapeutics
A Nonprofit Publication 		 

Automatic Renewal Form 

Dear Colleague:

The Medical Letter would like to offer their subscribers the ease and convenience of automatic subscription renewal for our subscription products.

The process is simple. Your subscription will be renewed each year with the credit card information kept on your personal subscription record. You will receive a reminder from us just before your credit card is charged, reminding you of the amount to be charged. It is very important that you advise The Medical Letter of any changes in your credit card information.

Please indicate which subscription(s) you would like to automatically renew:
The Medical Letter newsletter
The Medical Letter Bound Volume (hardcover)
Treatment Guidelines newsletter
Treatment Guidelines Bound Volume (hardcover)
Continuing Medical Information (CME) from The Medical Letter

Please print this form, fill it out and mail or fax it to us at The Medical Letter.

Mail:
The Medical Letter
145 Huguenot Street, Suite 312
New Rochelle, NY   10801-7537		 Fax:
(914) 632-1733
Subscriber name and address information
Name: _________________________________________________________________
Address: _______________________________________________________________
City: _________________________  State:  _____________  Zip Code: ____________

Credit Card information for automatic renewal

Charge My Account
VISA MasterCard American Express
Credit Card Number: _________________________   Exp. Date: __________ (month/year)
Cardholder Name:  _______________________________________________________
Zip code from card billing address:  _______________
Daytime Phone: ________________ Fax: __________________ e-mail: _____________
* Your signature is required in order to initiate the automatic renewal process.
* Signature:  _________________________________ Specialty ___________________
If paid by a company
Company name: ____________________________________________________
Company address: __________________________________________________