Order Form
Wachler & Associates, P.C.
210 E. Third Street
Suite 204
Royal Oak, MI 48067
(248) 544-0888
Fax: (248) 544-3111
http://www.wachler.com/
wapc@wachler.com
ORDER FORM
|
Quantity |
Description |
Price |
Amount |
| The HIPAA Privacy Workbook and Toolkit (includes CD-ROM and December 2002 Government Guidance) |
$195.00 |
||
| The HIPAA Privacy Training Video | $250.00 | ||
| The HIPAA Privacy Workbook and Toolkit and Training Video | $395.00 |
ORDER OPTIONS:
-
Mail Order Form to: 210 E. Third Street, Suite 204, Royal Oak, MI 48067
-
Fax Order Form to: (248) 544-3111
-
Order online @ http://www.wachler.com/
-
E-mail the following information to wapc@wachler.com
-
Call: (248) 544-0888
PAYMENT METHOD:
___ Check enclosed (payable to Wachler & Associates, P.C.)
or Credit Card: ___ MasterCard ___Visa
Card Number: ___________________ Exp. Date: ____/____/____
Cardholder's Name: ______________________________________
Cardholder's Signature: ___________________________________
Cardholder's Billing Address: _______________________________
_______________________________
SEND TO:
Name/Title: _____________________________________________
Organization: ____________________________________________
Address: _______________________________________________
City/State/Zip: __________________________________________
Phone/FAX: _____________________________________________
E-Mail: _________________________________________________
