Order Form

Order Form - print now

Phone				For information, phone orders, or a list of contents or sample pages from any manual, please visit our web site at www.apollomanagedcare.com or, call (805) 969-2606.
Fax or E-mail				For the fastest service, complete and fax this form, with credit card information to (805) 969-3749 (a secure #); or e-mail order information and any questions to apollomanagedcare@cox.net or mbischel@cox.net
Mail				Print and mail this form to Apollo Managed Care, 860 Ladera Lane, Santa Barbara, California 93108 with full payment or credit card information Please iunclude the shipping & handling fees and any required taxes.
*Name and Mailing Address of Recipient (Please* print clearly)**
Name and Title
Company
Address
City, State, and Zip/Postal Code								Country (unless USA)
Phone					Fax	e-mail
Method of Payment
	Check enclosed, payable to Apollo Managed Care Consultants
	Charge MasterCard or Visa account #: Exp. Date:
Print name on credit card; then sign authorized name – required for all charges:

Please send the Apollo publications listed below (use reverse, if needed)
How many?		Title of each manual, guideline volume or ‘Single Topic’ publications					Price each		Total









			Subtotal
			- 15% quantity discount, if ordering 6 or more
			+ Shipping & Handling *
Please add 8.75% sales tax if shipment is to California
			Total Amount - Enclosed or Charged
S & H: To cover our costs, please add $15.00 for the first manual plus $9.50 for each additional manual or guideline volume. For ‘Single Topics’, add $5.50 per publication. Please allow up to one week for mail delivery. Federal Express, UPS or other ‘overnight’ couriers can be charged to your account. Save all shipping and handling charges. Let us send the publication to you by e-mail as an attachment to print at your location.*									Thank you. Please take a 15% discount for 6 or more (any combination) Apollo publications.