Form K-Wc 300 - Order Form For Workers Compensation Publications - 2016
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1KANSAS DEPARTMENT OF LABOR
ORDER FORM FOR WORKERS COMPENSATION PUBLICATIONS
K-WC 300 (Rev. 2-16)
The Schedule of Medical Fees is also available at: /WorkComp/medfeesched.aspx
The Laws & Regulations book is also available at: /WorkComp/frmpub2.aspx
Schedule of Medical Fees – Jan. 1, 2015
$
Excel file via email (single table of codes & maximum fees only) @ $40.00
________
Laws & Regulations – April 25, 2013
Complete Edition (includes updated pages and binder; 136 pages)
$
_____ copies @ $______ per copy postpaid
________
17.50
0.00
Updated pages only (102 Pages)
$
______ copies @ $______ per copy postpaid
________
10.00
0.00
Product Total
$
________
0.00
Service Charges:(Select only one payment option listed below)
The payment option not used should be set at zero.
$________
0.00
If paying by check, $1.50 will be added to the Product Total.
0.00
$________
0.00
If paying by credit card, 2.5% charge will be added to the Product Total.
0.00
ORDER TOTAL $________
0.00
*
Required field
*Purchaser’s name: ______________________________________________________________
Business name: _________________________________________________________________
*Mailing address: ________________________________________________________________
*City: ________________________________________ *State: _______ *ZIP: ________________
(
)
*Phone: _________________________ *Email: _________________________________________
PAYMENT OPTIONS
•
Personal or Business Check: The Kansas Department of Labor is now using KanPay to process check
payments for security purposes. Please add $1.50 to the product total for a processing service charge.
Mail your check payable to the Kansas Division of Workers Compensation to:
Kansas Department of Labor
Division of Workers Compensation
401 SW Topeka Blvd., Suite 2
Topeka, KS 66603-3105
•
Credit Card: The Kansas Department of Labor is now using KanPay to process credit card payments
for security purposes. A 2.5% service charge will be added to the product total. You will receive a
KanPay receipt of payment by email.
c VISA
c MasterCard
Card #
c Discover c American Express
Expiration Date: MO
YR
Name as it appears on card: __________________________________________
Or call: Division of Workers Compensation (785) 296-4000, ext. 2131 FAX: (785) 296-0839
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