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HFMA Store Order Form

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Contact Information:
*First Name:   
*Last Name:   
HFMA Member ID:   
Title:  
Organization:  
* Street Address Line 1:  
Street Address Line 2:  
* City:  
* State:  
* Zip:  
Country:  
Phone #:    - -    ext.
Cell Phone #:   
Product Qty Unit Price

2009 Glossary

    
Glossary (1 copy) $30

HFMA Principles and Practices Board Issue Analysis 05-01
Member Price $17.50
Non-Member Price $22.00

Compliance Checklists
For Clinical Laboratories $25.00
For Group Physician Practices $25.00
For Home Health Agencies $25.00
For Medicare + Choice $25.00
For Nursing Facilities $25.00
For Third-Party Billing Companies $25.00
For Durable Medical Equipment $25.00
Merchandise Total
Tax
(Illinois residents only;
Add 9% of merchandise total for tax.)
 Shipping
$ 25 Expedite Processing Fee
Total Price
 
Note: Please allow 2 business days for processing orders. If expedite shipping is not requested, all orders are shipped via UPS ground service and arrive in 5-10 business days, contingent on destination. UPS cannot ship to a P.O. Box number.

Payment Information
Note: Make checks payable to HFMA and include the printed form with your payment. Mail to: HFMA Attention: Member Service Center, 2 Westbrook Corporate Center, Suite 700, Westchester, IL 60154