Division of Workers Compensation
ORDER FORM
www.dol.ks.gov
This publication is also available at
Law & Regulations July 2007
Law & Regulations Book ........................______ copies @ $12.00 per copy $______________
TOTAL
$______________
Purchaser's Name: ____________________________________________________________________ Company Name: _____________________________________________________________________ Mailing Address: (street) ________________________________________________________________
(city)
_________________________________ (state) ___________________ (zip) _________________
( ) Phone Number:__________________________________
Please send check or money order payable to the Kansas Division of Workers Compensation to: Kansas Department of Labor Division of Workers Compensation 800 S.W. Jackson Street, Suite 600 Topeka, KS 66612-1227 Orders using Visa/Mastercard should be called in to the Division of Workers Compensation at 785-296-3441.
K-WC 300 (Rev. 8-07)