| 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
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