The cost of the entire handbook is $10.00 per copy. If you already have the handbook and wish to receive update pages only, the cost is $5.00 per copy.

If you wish to place your order for either of the above, please fill in the appropriate areas on this form and submit with a check made payable to the Michigan Workers’ Compensation Placement Facility (MWCPF).

Agency/Company Name:                                                                                                               

Mailing Address:                                                                                                                            

City, State, Zip:                                                                                                                              

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I would like to receive       copies of the Information & Procedures handbook at $10.00 each.

I would like to receive      copies of the  update pages for the Information & Procedures Handbook at $5.00 each.