Page 17 of hcfa cms 1500 health insurance business forms
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Custom Carbonless 2-Part Examination Report Forms, 4" x 5-1/2", 50 Sets per Pad
Item #: 901-QFN131141R
Use to provide costs and services to patients and for use in patient charts
4" W x 5-1/2" L
2-part, white/canary, carbonless; printed in black ink
Custom Minor/Child Consent Form Slips, 5-1/2" x 4", 100 Sheets per Pad
Item #: 901-QFN134XX1R
For consent to provide treatment to a minor or child
5-1/2" W x 4" L
White 20# text stock; printed in black ink
Sof-Form® Non-sterile Conforming Gauze Bandages; 75" L x 2" W, 96/Pack
Item #: 901-113612MED
Rayon/Polyester Material
Non-sterile
Latex-free
$22.59
Per carton
TOPS™ Perforated Guest Check Pad, 1-Part, 50 Sheets/Pad (525SW)
Item #: 901-196287
Perforated Guest Check Pads to keep track of messages, finances, transactions, employees and taxes
Dimensions: 3"H x 3.4"W x 6.75"L, 6.25" x 3.4" (detached form), 6.75" x 3.4" (sheet)
Color: White (primary page), green (ink)
$10.99
Per pack
Business Checks & Custom Forms
Item #: 901-BCCF
Personal and business checks with an extensive selection of designs, features and related products
The latest in proven security and anti-fraud features to deter check alteration and enable check authentication
The latest in proven security and anti-fraud features to deter check alteration and enable check authentication
$108.99
1 each
Save 29%
$76.99
8+ each
Adams 2025 1099 Tax Envelopes, 3-Up Format, Double-Window, Security Tinted, Peel & Seal, White, 25/Pack (STAX3-25)
Item #: 901-24639725
1099 envelopes are designed to fit your 3-per-page 1099-NEC forms and other 3-up tax forms
3-3/4"L x 8-3/4"W
White wove; 24 lb.
$15.99
Per pack
Adams 2025 1099 Envelopes, 2-Up Format, Double-Window, Self-Seal, Security Tinted, White, 25/Pack (STAX1-25)
Item #: 901-24639723
1099 envelopes are designed to fit your 2-per-page tax forms including the 1099-MISC, 1099-B, 1099-DIV, 1099-INT, 1099-K, 1099-OID, 1099-R, 1098, 1098C or 5498 forms
5-5/8"L x 9"W
White wove; 24 lb.
$15.99
Per pack
Adams Gummed W-2 Double Window Envelope, 3 7/8" x 8 1/4", White, 100/Pack (DW3ALT100)
Item #: 901-33331Q
W-2 Double Window Tax Envelopes are easy close, tinted for 100% security and are double-windowed to display both employer/payer and employee/recipient addresses
Use with LW23UPALT tax forms
24-lb. white wove stock
$72.19
1-5 pack
($0.72/EACH)
Save 7%
$66.99
6+ pack
($0.67/EACH)
ComplyRight Self Seal Security Tinted Double-Window Tax Envelopes, 5 5/8" x 9", 50/Pack (9999250)
Item #: 901-24507968
Double-window envelopes for 4-Up W-2 (5205/5205A/5209) tax form.
Self-sealing for added convenience.
Pack of 50 envelopes.
$49.89
1-7 each
Save 8%
$45.99
8+ each
ComplyRight Self Seal Security Tinted Double-Window Tax Envelopes, 3 7/8" x 8 3/8", 50/Pack (DW19WS50)
Item #: 901-24507904
Double-window envelope for 3-Up 1099 tax form.
Self-sealing for added convenience.
Pack of 50 envelopes.
$39.29
Per each
Adams Self Seal Security Tinted Double Window Envelope, 3.75" x 8.5", White, 100/Pack (S1099-3PS)
Item #: 901-24496514
Simple, high-quality envelope for 1099-NEC tax forms
Dimensions: 3.75" x 8.5"
Made of white paper
$105.99
1-8 pack
($1.06/EACH)
Save 19%
$85.99
9+ pack
($0.86/EACH)
TOPS Job 3-Part Carbonless Work Orders, 8.62"L x 5.67"W, 50 Sets/Book (3868)
Item #: 901-3868
Job work-order forms designed to provide a space for work, costs, and totals
Business-form size: 8.62"L x 5.67"W
3-Part Carbonless forms for accurate record keeping
$37.99
1-4 pack
($0.76/EACH)
Save 5%
$35.99
5+ pack
($0.72/EACH)
Adams 2025 W-2 Envelopes, Double-Window Design, Security Tinted, Peel & Seal Self-Seal Closure, White, 25/Pack (STAX2-25)
Item #: 901-24639724
W-2 envelopes are designed to fit standard IRS W-2 Forms
5-5/8"L x 9"W
White wove; 24 lb.
$15.99
Per pack
ComplyRight Self Seal Security Tinted Double-Window Tax Envelopes, White, 50/Pack (3333250)
Item #: 901-24507957
Double-window envelope for W-2 (5210/5211) tax form.
Self-sealing for added convenience.
Pack of 50 envelopes.
$50.99
1-7 each
Save 27%
$36.99
8+ each
ComplyRight Self Seal Security Tinted Double-Window Tax Envelopes, White, 25/Pack (7777225)
Item #: 901-24507916
Double-window envelope for 2-Up 1099 tax form.
Self-sealing for added convenience.
Pack of 25 envelopes.
$39.29
1-7 each
Save 24%
$29.99
8+ each
Adams 3-Part Carbonless Bill of Lading, 8.5"L x 7.44"W, 250 Sets/Book (B3876)
Item #: 901-196253
Bill of lading form to ensure all your shipments arrive with the appropriate paperwork
Business form size: 8.5"L x 7.44"W; detached form size: 8.5"L x 6.94"W
3-Part Carbonless forms for accurate record keeping
$43.99
1-3 pack
Save 5%
$41.99
4+ pack
ComplyRight Moistenable Glue Security Tinted Double-Window Tax Envelopes, 5 5/8" x 9", 100/Pack (99991100)
Item #: 901-24431087
Double-window envelope accommodates W-2 forms 5205, 5205A, and 5209.
Features a moisture/gum-seal flap.
Pack of 100 envelopes.
$67.89
Per each
ComplyRight Moistenable Glue Security Tinted Double-Window Tax Envelopes, White, 50/Pack (7777150)
Item #: 901-24507932
Double-window envelope for 2-Up 1099 tax form.
Features a moisture/gum-seal flap.
Pack of 50 envelopes.
$43.59
Per each
ComplyRight Moistenable Glue Security Tinted Double-Window Tax Envelopes, 3 7/8" x 8 3/8", 50/Pack (DW19W)
Item #: 901-24507972
Double-window envelope for 3-Up 1099 tax form.
Features a moisture/gum-seal flap.
Pack of 50 envelopes.
$39.29
Per each
ComplyRight CMS-1500 Self Seal Security Tinted Window Envelope 9" x 12 1/2", White/Blue, 100/Pack (1500RS)
Item #: 901-1949161
Envelope holds up to 50 CMS-1500 unfolded claim forms.
Helps reduce processing delays.
Right-window reveals only the mailing address.
$61.99
Per each
Adams 2-Part Carbonless Work Orders, 8.375" x 10.4375", 50 Sets/Book (DC8100)
Item #: 901-196139
Carbonless sales order form book for two-part forms and copies without smudging
White and canary in color and smooth finish paper
One 50-set book per pack
$20.99
1-4 each
Save 5%
$19.99
5+ each
ComplyRight Moistenable Glue Security Tinted Tax Envelope, White, 100/Pack (61611100)
Item #: 901-24431090
Double-window envelope accommodates 4-Up 1099-R (5175) forms.
Features a moisture/gum-seal flap.
Pack of 100 envelopes.
$45.69
Per each
TOPS™ Repair Order Book, 2-Part, 50 Sheets/Book (D5084)
Item #: 901-843516
Repair Order book is perfect for repair and general work jobs
Dimensions: 0.38"H x 8.44"W x 5.56"L, 7.94" x 5.56" (detached form), 5.56" x 8.44" (sheet)
Color: White (primary page), white (duplicate page), blue (ink)
$9.49
1-9 each
Save 11%
$8.49
10+ each
ComplyRight Moistenable Glue Security Tinted Double-Window Tax Envelopes, 5 5/8" x 9.25", 50/Pack (6666150)
Item #: 901-24507911
Double-window envelope for W-2 tax form.
Features a moisture/gum-seal flap.
Pack of 50 envelopes.
$33.99
1-3 each
Save 9%
$30.99
4+ each
