ORDER FORM FOR TECHNICAL ASPECTS OF INSURANCE
CLAIMS INVESTIGATIONS
Name:_______________________________
Address:_____________________________
____________________________________
____________________________________
Phone:_______________________________
Email________________________________
.............Number of copies ___ x $99 ea =___________
..........................Illinois Sales Tax (6.5%) =___________
.................................Shipping @ $7.50 ea = ___________
(Shipping for 3 or more copies @ $5 ea) = ___________
............................................................Total =___________
Make check or money order out to: Roberts Publishing
ROBERTS PUBLISHING
2090 Brush Grove Road
Rochelle, Illinois 61068
Phone: 877-556-3039
Fax: 815-562-9071
Email: ccr@croberts.com