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ORDER FORM - 2018 UBA Health Plan Survey EXECUTIVE SUMMARY

Thank you for choosing to order the 2018 UBA Health Plan Survey Executive Summary. UBA will be accepting orders through October 8, 2018. If you are ordering co-branded brochures, you will receive a proof the week of October 15. Printed brochures will be distributed to UBA Partners the week of October 22.

Pricing for the brochures will be based upon the combined Partner orders to achieve the lowest possible cost per piece. The higher the number of pieces ordered, the lower the cost per piece will be. The following are the pricing estimates you can expect based upon previous combined printing orders:

Standard UBA-branded brochures will range from $0.60 to $0.95 per brochure + shipping
Co-branded brochures will range from $1.25 to $2.00 per brochure + shipping

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* 1. Name of the Partner Firm submitting orders

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* 2. Email Address: (contact person for questions)

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* 3. Name: (person who is ordering the brochures)

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* 4. Address: (where the brochures will be delivered)

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* 5. Address 2:

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* 6. City:

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* 7. State:

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* 8. Zip Code:

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* 9. Company Phone:

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* 10. Website URL:

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* 11. I would like to order Standard UBA-branded brochures (does not include my Firm logo or my contact information)

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* 12. I would like to order Co-branded brochures (includes my Firm logo on the front cover and my Firm logo and address on the back cover

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* 13. CO-BRANDED BROCHURES ONLY - If the address and contact information above is different than the address and contact information that you would like to appear on the back of the printed co-branded brochure, please type in the address and contact information below:

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* 14. CO-BRANDED BROCHURES ONLY - If you would like to order brochures for MORE THAN ONE OFFICE LOCATION, please type in the additional address and order quantity below:

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