Request For Manuals From Claims Training
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Request For Manuals From Claims Training Form. This is a Washington form and can be use in Claims Workers Comp.
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Tags: Request For Manuals From Claims Training, F241-021-000, Washington Workers Comp, Claims
Department of Labor and Industries
Cashier’s Office
P.O. Box 44835
Olympia, WA 98504-4835
REQUEST FOR MANUALS
FROM CLAIMS TRAINING
RESET
Number of
Paper
Manuals
in Binders
Requested
Paper
Manual in
Binder Price
Per Unit
Number
CDs
Requested
Manuals on
CD Price
Per Unit
Claims Administration
Policy Manual (PM)
N/A
N/A
$57.92**
Workers’ Compensation
Adjudicator (WCA) and Claims
Management (CM) Manuals (Not
sold separately)
N/A
N/A
$119.41**
$5.21*
$170.65**
Type of Manual Requested
Workers’ Compensation
Adjudicator (WCA), Claims
Management (CM) and Policy
Total
Cost
Manuals for all 3.
*Price includes CD, tax, and shipping.
**Price includes printing, binders, tax, and shipping.
Total Amount
Enclosed
Shipping Information
(Please Print)
Name
Title
Phone Number
Business Name
Street Address
PO Box
City
State
ZIP + 4
PLEASE ALLOW UP TO 4 WEEKS FOR DELIVERY
Mail this form and your check to:
Department of Labor and Industries
Cashier’s Office
P.O. Box 44835
Olympia, WA 98504-4835
LABOR AND INDUSTRIES OFFICE USE ONLY
Cashier Office Received (See Claims Training Code Sheet):
Date:
Please forward this form to Claims Training MS: 4208 after completion.
F241-021-000 Request for Manuals From Claims Training 06-2011
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