Page 18 of hcfa cms 1500 health insurance business forms
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Delforms® One-Write General Expense Check Refills; 250 per Pack, without Duplicates
Item #: 901-111011
No messy carbon paper
Eliminates copy errors and saves time
Security features include erasure protection; micro-print signature line; chemical-sensitive paper; padlock icon and warning; security screen and warning box
Adams Receipts Book, 2.75"L x 5.38"W, 50 Sheets/Book, 3/Pack (DC2501-3)
Item #: 901-448239
Item #: 901-448239
Money and rent receipt book is consecutively numbered for easy organization
Size: 2.75"L x 5.38"W
Features a carbonless 2-part format that allows you to keep a permanent copy for your records
$19.99
1-4 pack
Save 5%
$18.99
5+ pack
Rediform® Carbonless Delivery Receipt Books, 4-1/4" x 6-3/8", 2 Part
Item #: 901-508625
Item #: 901-508625
$13.99
Per each
TOPS™ Money/Rent Receipt Book, 3-Part, 50 Sheets/Book (TC2701-3)
Item #: 901-448242
Item #: 901-448242
Money/Rent Receipt book to offer receipts for rent and other monetary exchanges at
Dimensions: 1.5"H x 2.75"W x 7.19"L, 6.69" x 2.75" (detached form), 7.19" x 2.75" (sheet)
Color: White (primary page), pink (triplicate page), canary (duplicate page), blue (ink)
$27.99
Per each
Custom Cash Receipt Book, 4-to-a-page, Triplicate, 200 Sets/Book
Item #: 901-TCRB1203
4-Up
Triplicate
200 sets per book
Custom Cash Receipt Book, 3-to-a-page, Duplicate, 225 Sets/Book
Item #: 901-TCRB1182
3-Up
Dupllicate
225 sets per book
Adams 2-Part Carbonless Guest Checks, 4.25"L x 7.25"W, 250 Sets/Book (947SWC)
Item #: 901-947SWC
Item #: 901-947SWC
Guest check form is used to record the receipt of petty cash, rent, or other payments
Buziness form size: 4.25"L x 7.24"W; detached form size: 6.75"L x 4.25"W
2-Part Carbonless forms for accurate record keeping
$31.99
Per pack
TOPS Credit Card Sales 3-Part Carbonless Receipts, 3.25"L x 7.88"W, 100 Sets/Book, 5/Carton (38538CT)
Item #: 901-810999CT
Item #: 901-810999CT
Triplicate Credit Card Sales Slips are made with carbonless paper to protect your customers; no carbon tissues containing credit card information to worry about
Size: 3.25"L x 7.88"W
Features a carbonless 3-part format and comes in white
$119.99
1-2 carton
Save 8%
$109.99
3+ carton
Custom Sales Slips, Classic Design, Large Format 2 Parts, 1 Color Printing, 5 2/3" x 8 1/2", 500/Pack
Item #: 901-D812
Custom printed business forms, with time-saving features & expert personalization
16 lines for writing up larger sales
Carbonless 2- or 3-part forms stay tightly aligned for clear, clean copies
TOPS Snap-Off 3-Part Carbonless Packing Slips, 8-1/2" x 7", 50 Sets/Book (3834)
Item #: 901-377682
Item #: 901-377682
Complete with all necessary documentation for shipments
3-part carbonless, white, canary, pink paper sequence
Not numbered
$38.99
1-4 box
Save 5%
$36.99
5+ box
Custom Work Orders, Carbonless, Small Format 2 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-D2112
Custom printed business forms, with time-saving features & expert personalization
16 lines for materials, plus space for labor & other costs
Signature line for customer authorization prevents disputes
TOPS 3-Part Carbonless Bill of Lading, 8.5"L x 7.44"W, 250 Sets/Book, /Box (L3841)
Item #: 901-508568
Item #: 901-508568
Bill of lading form to ensure all your shipments arrive with the appropriate paperwork
Size: 8.5"L x 7.44"W
Features a carbonless 3-part format that allows you to keep a permanent copy for your records
$99.99
Per box
Custom Service Orders, Carbon, Small Format 3 Parts, 1 Color Printing, 5 2/3" x 8 1/2", 500/Pack
Item #: 901-D3073
Custom printed business forms, with time-saving features & expert personalization
Signature line for customer authorization prevents disputes
Carbon-backed sets available in 2, 3 or 4 parts
Custom Carbonless Numbered Blue Receipt Books, 4-3/4" x 2-3/4", 500 Receipts per Book
Item #: 901-QFW1202201
Self-duplicating; everything is printed on original and duplicate
Book size is 11-1/2" W x 8-1/2" L; detached receipt size is 4-3/4" W x 2-3/4" L
Blue self-duplicating carbonless stock; pre-printed in black and blue ink
Custom Statements, Laser, 1 Parts, 1 Color Printing, 8 1/2" x 11", 500/Pack
Item #: 901-D13437G1
Handy aging section! Statement includes an account aging section at bottom for current and past due amounts
Consecutive numbering available
Promote your business: Personalization includes your imprint plus choice of typeface and standard logo
Medical Arts Press Standard Preprinted Chart Divider Tabs, Patient Information, Orange (30583)
Item #: 901-30583
Item #: 901-30583
Orange tab
100/box
Titles are printed in black ink on white stock with a color-coded edge
$10.49
Per pack
($0.10/EACH)
Custom Classic Small Sales Slips 3 Parts, 1 Color Printing, 4 1/4" x 7", 500/Pack
Item #: 901-D803
Consecutive numbering available
Convenient: Snapset Format
Consecutive numbering: These forms come with the option to have consecutive numbering printed on them
Custom Service Orders, Road/Towing, Booked, Small Format 2 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-D25252
Manage tasks: Small format business form simplifies paperwork at the shop or site with pre-printed checkboxes and itemization of charges
Track customer acceptance: Signature line for customer authorization prevents disputes
Stay organized: Bottom copy stays bound in towing receipt book for a permanent record; 50 sets per book
Custom Cash Receipt Book, 4-to-a-page, Duplicate, 300 Sets/Book
Item #: 901-TCRB1142
4-Up
Duplicate
300 sets per book
TOPS® Bill of Lading Unit Set, Ruled, 4-Part Carbonless, 11-7/16" x 8-1/2", 50/Pack (3847)
Item #: 901-903257
Item #: 901-903257
Originals are printed in Light Blue, duplicates in Blue
White carbonless paper
Hazardous material information areas are printed in Red
$79.99
1-4 box
Save 5%
$75.99
5+ box
Rediform 2-Part Carbonless Purchase Requisitions, 8.5"L x 11"W, 50 Sets/Book (RED1L146)
Item #: 901-2675658
Item #: 901-2675658
Purchase order book.
17 lines
Brand: Rediform
$36.99
Per each
Medical Receipt Books; Blank
Item #: 901-MRB109NI
Keep a permanent record of patient payments in chronological order
3-parts; parts one & two are perforated, part three remains in book as permanent record
Includes insert to prevent write-through
Custom Snap Apart Sales Slips, 2 part, 7" x 4-1/4", 500 Sheets
Item #: 901-TGSCC6532
2-part carbonless
Sales slip measures 7"Hx4-1/4"W
500 loose sheets
ComplyRight Patient Acknowledgment of Receipt of Privacy Practices Notice (A1354)
Item #: 901-398026
Item #: 901-398026
Attorney approved form acknowledging patient has received a Notice of Privacy Practices from his or her healthcare provider
HIPAA compliant
Size: 8 1/2" x 11"
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