CLAIMS PROVIDERS
of AMERICA
P.O. Box 270529
San Diego, CA 92198-0529
Phone: (800) 735-6660
Fax: (858) 487-7747

Fax/Mail Order Form

Use this form if you prefer to fax or mail your order for copies of the National Directory of Expert Witnesses. Just print the form on your printer, fill in the information requested below, and fax the completed form to (858) 487-7747 or mail it to the following address (allow approximately two weeks for delivery):

    The National Directory of Expert Witnesses
    Publications Department
    P.O. Box 270529
    San Diego, CA  92198-0529

(To order copies of the directory online, click here for a secure Online Order Form.)

-- The National Directory of Expert Witnesses --

Name:    ____________________________________________

Company: ____________________________________________

Address: ____________________________________________

City:    __________________ State: ___ Zip:__________

Phone:   ____________________   Fax:_________________

No. of copies: @ $45.00/copy = Total Amount $_______

Payment: ___ Check enclosed   ___ Check to follow*

____ Visa/MC ____ American Express  ____ Discover

Card No. _________/_________/_________/_________/

Expiration Date: ________

Authorized Signature: ______________________________

*  Make checks payable to "The National Directory of Expert Witnesses" and mail to address shown above. Order cannot be processed until payment has been received.

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