The setting of proper and reasonable fees is critical to maintaining a healthy and profitable practice.

We can help.
Choose the option that is best for you.

"Do-It-Yourself"  -  If you are the type of person who likes to review all possible scenarios and options, we recommend our complete $99 software program: InstaFee$ & Files  (click here)

"We do it for you!"  -  Don't have time or you're not the "do-it-yourself" type?  We'll be happy to do it for you for only $149.  Simply send us (mail, email or fax) your list of codes (computer printouts, "superbills" or hand notes). It's that simple! From your codes, we create your customized reports and mail (or email) them to you!

Order today in 3 easy ways:

Online	Fax	Mail
Go to our eStore. Don't forget to fax or email your codes and/or specialty to us.	Complete the order form below then Fax toll free:  (877) 272-0780	Complete the order form below then Send to:  InstaCode Institute                2314 W 8900 N                Dammeron Vly UT 84783

Questions?

Call us at: 877-963-2633 (Toll Free)

Or eMail us at:

Customer Information

Name:
Title/Position:
Company/Practice:
Address 1:
Address 2:
City:
State:	--- please select --- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming
ZIP/Postal Code:
Country:  *	US             Other
Phone:
FAX:
Email:
Additional Comments, Instructions?	please do not place your fees in this box

Order Information

Description	Quantity	Price
Customized Fee Analysis WE will run customized reports to show you what your fees should be.		$149
Subtotal:		$
Utah residents - your 5.9% sales tax will be calculated automatically
Standard Service: 1-2 weeks Rush Service: 2 days +$15
Payment Method:        Check    Credit Card Please make checks payable to InstaCode Institute Please note that submitted forms and fees without payment cannot be processed until payment is received.

Payment Information

Credit card	VISA MasterCard American Express Discover
Cardholder name
Card number
Expiration date	mm/yy
	BILLING INFORMATION (enter only if different than Shipping address above)
Name
Company
Address 1
Address 2
City
State
ZIP/Postal Code
Country *	US             Other
Phone

Order Submission

1. Print this form
   
2. Send us copies of your (legible) computer printouts, "superbills" or hand notes.
   
3. Include your payment
   
4. Mail or Fax to:

FAX:	(877) 272-0780
Mail:	InstaCode Institute 2314 West 8900 North Dammeron Valley, Utah  84783

Allow 1-2 weeks for your analysis to arrive (if you need it faster, select Rush processing and your order can be emailed in 1-2 business days)

Thank you for your order.

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