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ORDER FORM
( To print form click File and then click Print on the dropdown menu. )


2009 price list & order form
Orders accepted by fax, phone and email. Purchase orders are accepted. 
Orders can be billed (terms net 30), Visa and MasterCard are accepted.
(800) 328-4144     fax (310) 472-0112     email to fbka@fbka.com


  KELLYDIRECTORY.COM
Internet publication - Computer data file the Nationwide Hospital Insurance Billing Directory and Casualty Insurance Claims Directory books are based upon. Includes some things not possible in books --  internet web site links to almost all listings, point & click cross references  etc.   -- the ultimate in patient accounts!

(        ) MULTI  USER PLAN ANNUAL- $900/yr./each - allows unlimited online facility users (KELLYDIRECTORY.COM)

(        ) SINGLE  USER PLAN ANNUAL - $300/yr./each - allows one user online at a time (KDCOM.US)      

The KellyDirectory.com service covers hospital/medical payment offices insurance companies, Workers' Compensation and Auto Medical claims payment offices TPA's, Blue Cross-Blue Shield, Medicare, Medicaid, Tricare, ChampVA, Supplements, federal employee plans, INDEMNITY, HMO, POS, PPO,  Insurance commissioners,  fleets of ins. co.'s and text. Those listed probably pay over 95% of hospital/medical insurance claims.  Subscribers are issued a unique User ID and Password on receipt of subscription order. Subscriptions stay in effect until canceled by the subscriber.

Payment (     ) Visa    (     ) MasterCard     (      ) Check     (      ) Bill
Make check to Francis B. Kelly and Associates, Inc. --- TIN 95-3138833 for form 1099

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Credit card No.                                                                 Expiration                  
                                                         
P.O.  No. ( if applies)_________________________________________


Buyer Name.______________________________________________________________________Date___________________


Shipping  Address_________________________________________________City_______________St_____Zip_______________


Attn Name______________________________________Title___________________________Ph(     )____________________


Email addresses__________________________________________________________________________________________



Signature__________________________________________Print Name__________________________________
On prepaid orders shipping charge is waived. (California buyers add tax)

Buyer agrees not to copy nor allow copying from any of the above items for competitive publishing and to be
liable for economic loss to publisher, and or gain accruing to others, thereby.

                  Francis B. Kelly & Associates, Inc.
                  P.O. Box 490294, Los Angeles, CA 90049
                  (800) 328-4144 - fax (310) 472-0112 - email to fbka@fbka.com