Workers Compensation Order Form

The Department of Industrial Relations makes available the following aid to assist the public in becoming knowledgeable of Departmental operations. UNIT TOTAL DESCRIPTION PRICE AMOUNT QTY. ____ Copy of DIR Administrative Code. This is a loose leaf copy of all Department Administrative Rules. Updates will be provided by subscribing to the Advance Notice of Rulemaking Proceedings. Subscription to Advance Notice of Rulemaking Proceedings for one year. This is notification by letter of rule making hearings and the adoption of emergency rules. You will be sent a subscription form at the end of the fiscal year. Direct product/service questions to Teresa Davis, (334) 242-2868. $35.00 $_______ ____ $25.00 $_______ ____ Copy of the 2003 Edition of the Workers' Compensation Law Book Annotated. This is a reprint of the Code of Alabama, 1975, Section 25-5. You will be sent an order form when future editions become available. 2005 Alabama Workers' Compensation Maximum Fee Schedules $25.00 $_______ This may be ordered in printed booklet form and/or 3.5 inch, 1.44mb diskette in ASCII format as indicated below. ____ PRINTED booklet of Workers' Compensation Fee Schedules for Medical Providers. $45.00 $_______ ____ DISKETTE COPY of Workers' Compensation Fee Schedules for Medical Providers $30.00 $_______ ____ DISCOUNT PACKAGE (Save $22.00) Printed Booklet & Diskette $53.00 $_______ ____ E-MAIL COPY of Workers' Compensation Fee Schedules for Medical Providers $25.00 $_______ Direct product/service questions to Trevor Perry, (334) 242-2868 or 1800-528-5166. Please fill in the following: Total Enclosed $_______ Contact Name______________________________________________________________________________________ Business Name_____________________________________________________________________________________ Address___________________________________________________________________________________________ City _______________________________________________ State Telephone Number ( ) __________________________________________ Zip_______________ E-mail address _________________________________________________________________________________ Please send this order form with a check or money order made payable to Alabama Department of Industrial Relations to: Alabama Department of Industrial Relations Finance Division ATTN: Central Cashier 649 Monroe Street Montgomery, AL 36131-2270 American LegalNet, Inc. www.USCourtForms.com