Free F241-021-000 Request for Manuals from Claims Training - Washington


File Size: 114.1 kB
Pages: 1
Date: June 16, 2005
File Format: PDF
State: Washington
Category: Workers Compensation
Author: Forms Management
Word Count: 163 Words, 1,058 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.lni.wa.gov/Forms/pdf/241021af.pdf

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Preview F241-021-000 Request for Manuals from Claims Training
Department of Labor and Industries Cashier's Office PO Box 44835 Olympia WA 98504-4835

REQUEST FOR MANUALS FROM CLAIMS TRAINING
Number Requested Price Per Unit $49.44* $79.44* (Manual Set) Not sold separately Total Amount Enclosed
$0.00

RESET
Type of Manual Requested Total Cost

State Fund Claims Policy Manual Manual Set
Workers' Compensation Adjudicator (WCA) Manual and Claims Management (CM) Manual

*Price includes printing, binders, tax and shipping. The breakdown of this manual price is available upon request.

Shipping Information
Name of Person Title Business Name Mailing address (Street address only ­ no PO Box)

Phone

City

State

ZIP + 4

PLEASE ALLOW UP TO 4 WEEKS FOR DELIVERY Return this form and your check to:
Department of Labor and Industries Cashier's Office PO Box 44835 Olympia WA 98504-4835

LABOR AND INDUSTRIES OFFICE USE ONLY Cashier Office Received (See Claims Training Code Sheet) Date

Please return this form to Claims Training, MS4208, after completion.

F241-021-000 request for manuals from claims training 05-2005