Workers’ Compensation Insurance Rating Bureau of California
®
WCIRB Publications Order
Form 802 (Rev. 12/2019)
1221 Broadway, Suite 900 Voice 888.229.2472 customerservice@wcirb.com
Oakland, CA 94612 wcirb.com
Form CS802.122019
All products and services are prepared by the WCIRB in the normal course of business
pursuant to the regulations of the California Department of Insurance or for the benefit of
the WCIRB’s members. The WCIRB has made reasonable efforts to ensure the accuracy
of the products and services.
You must make an independent assessment regarding the use of all WCIRB products and
services based upon your particular facts and circumstances. The WCIRB cannot make
such an assessment and shall not be liable for any damages, of any kind, whether direct,
indirect, incidental, punitive or consequential, arising from the use, inability to use, or
reliance upon WCIRB products and services.
Instructions
Purpose of Form
Use this form to order WCIRB products listed on the WCIRB
website, wcirb.com.
Payment Method
The WCIRB must receive payment before processing the
order. Indicate the payment method and corresponding
authorization information in section B.
• Direct billing is available for WCIRB member insurers.
• The WCIRB accepts Visa
®
and Mastercard
®
or ACH.
Authorize.Net will email an electronic invoice to the
requester on behalf of WCIRB California and process the
credit card or ACH payment.
Product Delivery
The WCIRB delivery and handling (D/H) charge is
applicable to all orders. Refer to the chart below and add the
appropriate amount for your order. The delivery charge is per
unit of product; for example, if you order 5 units of the same
product or 1 unit each of 5 different, the total D/H charge is
five times the unit charge.
Delivery Method D/H Fee
Electronically $5 per unit
Form Submission
This form can be completed electronically or printed out
and completed on hard copy. Electronic signatures are
acceptable when a signature is required. This form may be
emailed or mailed.
Email customerservice@wcirb.com
Mail WCIRB California
Attention: Contact Center
1221 Broadway, Suite 900
Oakland, CA 94612
Questions/Additional Information
Call the WCIRB Contact Center toll free:
888. CA WCIRB (229.2472), 7:30 AM – 4:45 PM PT
