Return to Home Page

Mail in Your Order

Print out this order form
and mail to:

The Financial Aid Center
P.O. Box 2200
Grants Pass, OR 97528

Your Medicaid Married Solutions Manual will be sent within one business day of receiving your order. We offer three different shipping options below.

For your convenience and protection, you can fill out this form and print it without transferring any information over the internet. Please fill out the form on your screen and hit the print button at the bottom when complete. Please be sure to accurately fill in all the required fields. Since this information is not sent over the internet before printing, we will not be able to check for completeness.

Medicaid Married Solutions Manual
Yes! I would like to order, for a one-time payment of $39.00 (plus shipping & handling) the Medicaid Married Solutions Manual, including specific information for every state, and which will explain 17 different stratagies that can be used to protect assets while qualifying a married person for Medicaid.
Shipping & Handling Options
$7.95First Class Mail by US Postal Sevice, Normally 2-4 days. Total $46.95
$30.00Special Shipping UPS Next Business Day Afternoon where available (physical address only-no PO Box) $69.00 Total
Select STATE Where Patient
Will Most Likely Apply For Medicaid:
(For statistical purposes only)
Enter Your Customer Information:
First Name:
Last Name:
Email:
Day Phone:
Evening Phone:
Enter Your Shipping Address
Physical Address or P.O. Box.
If Next Day Shipping Physical address only, No P.O. Box.
Address:

City:
State:
Zip:

I am enclosing a check or money order for $39 USD plus shipping & handling.


I want to charge this purchase to my Credit Card.

Enter Your Credit Card Information:
Card Type: Visa
MasterCard
Discover
American Express
Card Number:
Name on Card:
Expiration Date:   
CVV2: See examples below for more information.
On VISA, MASTERCARD and DISCOVER this is a 3 digit number in the signature area on the back of the card. \(it is the last 3 digits AFTER the credit card number\).
On AMERICAN EXPRESS cards, this is a 4 digit number printed above and to the right of the card number on the front of the card.
Enter Your Billing Address
Check here if your credit card billing address is the same as your shipping address and leave the following section blank.
Address:

City:
State:
Zip:
I authorize The Financial Aid Center for Long Term Care to charge $39.00 USD plus shipping & handling to my credit card for the purchase (and shipment) of the "Medicaid Married Solutions Manual".

Signature:  _______________________________________

     

Return to Home Page