Order Form

Please complete the following form to place your order (if you have any questions on placing an order please contact Pat Carbray of the Insurance Law Center at (860) 570-5184.)

Contact Name
Contact Title
Organization
Department
Phone    Fax
E-mail
Billing Address 1
Billing Address 2

City  

  
State   Zip   
Country

Shipping Address 

(if different than billing)

Shipping Address 2
City     
State   Zip   
Country
Please Check all that Apply:

  I would like to order (number) subscription(s) at $28.00 per subscription ($32.00 for international orders).

  I would like to order (number) complete set(s) of back issues (Volume 1 - Volume 11) at $150.00 per set ($165.00 for international orders).

  I would like to order (number) of the upcoming Asbestos    Issue(s), Volume 12:2, at $15.00 each.

  I would like to order the following back volumes or back issues at $15.00 per issue, $25.00 per volume (international orders are $18.00 per issue and $30.00 per volume).  Please list volume, issue and quantity for each (Ex. 4 copies, Volume 3, Issue 1):

Comments: