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ORDER FORM

2008 price list & order form -- indicate number or check bracket as applies
Phone, purchase orders & annual standing orders are accepted.  Visa, MasterCard & billing accepted
(800) 328-4144     FAX (310) 472-0112 
(To print form click File and then click Print on the dropdown menu)

  KELLYDIRECTORY.COM
Internet publication - Computer data file the 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,  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.

Limited copies of the hardcover publications available
____ 2006-2007 NATIONWIDE HOSPITAL INSURANCE BILLING DIRECTORY
 ( Health Insurance book) 
Price $ 150.00 + $ 9.80 shipping ea. The only directory exclusively of hospital/medical payment offices, TPA's, Blue Cross-Blue Shield, Medicare, Medicaid, Tricare, ChampVA, Supplements, federal employee plans, INDEMNITY, HMO, POS, PPO,  commissioners,  fleets of ins. co.'s and text. Those listed probably pay over 95% of hospital/medical insurance claims. 

_____2006 CASUALTY INSURANCE CLAIMS DIRECTORY 
(Workers' Comp & Auto Insurance book)
Price $ 150.00 + $ 9.80 shipping ea. Directory of Workers' Compensation and Auto Medical claims payment
offices. Includes TPA's, Insurance Commissioners, fleets of ins companies  and text. 8.5 by 11, over 300 pages,
hard cover bound. Lists probably over 95% of the U.S. casualty companies.

Shipping and payment info:   Payment (     ) Visa    (     ) MasterCard     (      ) Check     (      ) Bill
Make check to Francis B. Kelly and Associates, Inc. --- TIN 95-3138833

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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