Page 21 of hcfa cms 1500 health insurance business forms
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Adams 3-Part Carbonless Receipt Book, 10.88" x 7.63", 100 Sets/Book (TC1182)
Item #: 901-TC1182
Carbonless soft-cover money/receipt books for general receipts
Originals are white in color and copies are canary and pink in color and made of smooth carbonless paper for convenience
Contains one 100-receipt book per pack
$19.99
Per each
ComplyRight Self Seal 1099-R Tax Double-Window Envelope, 5.63" x 9", White, 100/Pack (DW4MWS)
Item #: 901-24578233
Double-window envelope for the 4-up 1099-R tax form
Dimensions: 5.63" x 9"
Comes in white
$37.99
Per each
TOPS™ Guest Check Pad, 1-Part, 100 Sheets/Pad (2100-12)
Item #: 901-196279
Guest Check pad is great for a home, office or business purpose
Dimensions: 3.35"H x 4.13"W x 5.44"L, 4.94" x 3.35" (detached form), 5.44" x 3.34" (sheet)
Color: White (primary page), blue (ink)
$16.99
Per pack
LUX W-2 / 1099 Envelopes (5 3/4 x 8) 50/Pack, White (7489-W2-50)
Item #: 901-23995716
Comes in White
Dimensions: 5.75"L x 8"W
Moistenable Glue Sealing Method
$48.99
Per pack
Medical Arts Press Invoices, 8-1/2" x 11", 500 Sets/Book, 505/Pack (30471D)
Item #: 901-30471D
Light Blue Background on Front
Back Is White with Printed Change Of Address & Visa & Mastercard Credit Card Payment Sections
Perforation Is 3.68 From top Of Sheet
$50.99
Per pack
($0.10/EACH)
ComplyRight Orthodontic Case Analysis File, 9.5" x 11.75", 25 Folders/Pack (A1048)
Item #: 901-24433069
Safely store patient records, record key patient information, case details, and benefits with this orthodontic case analysis file
Size: 9.5" x 11.75"
Beige sheet of paper with black text
$74.99
Per each
Adams 2-Part Carbonless Invoices, 5.5625" x 8.4375", 50 Sets/Book (DC5840)
Item #: 901-DC5840
Invoice book for keeping financial records of sales
White sheets for originals and canary for copies
Pack of one containing 50 invoices per book
$9.49
1-5 each
Save 5%
$8.99
6+ each
Adams 2-Part Carbonless Purchase Order, 8 3/8" x 11 7/16", 50 Sets/Book (DC8131)
Item #: 901-301655
2-part carbonless purchase order formbook in white, canary paper sequence
Consecutively numbered within each book
Space at top for company stamp
$21.99
1-9 each
Save 14%
$18.99
10+ each
Adams 2-Part Carbonless Sales Orders, 4.17"L x 7.2"W, 50 Sets/Book, 10/Box (DC4705-10)
Item #: 901-DC470510
Sales and order books are ideal for keeping proper records of orders and sales
Size: 7.19"L x 4.19"W
Features a carbonless 2-part format that allows you to keep a permanent copy for your records
$92.99
1-2 pack
($9.30/EACH)
Save 28%
$66.99
3+ pack
($6.70/EACH)
TOPS 3-Part Carbonless Sales Orders, 5-1/2" x 7-7/8", (46510)
Item #: 901-2667638
Numbered sales forms, unheaded columns
5-1/2" x 7-7/8"
Three-part carbonless (white, canary & pink)
$16.99
Per each
TOPS Petty Cash Receipt Book, 2.75"L x 5"W, 200/Pack (TOP4109)
Item #: 901-4109
Petty cash book is designed for cash payouts
Size: 2.75"L x 5"W
Features a carbonless 2-part format that allows you to keep a permanent copy for your records
$24.99
1-4 each
Save 8%
$22.99
5+ each
Better Office 2-Part Carbonless Sales Order Book, 4.13" x 7.19", 50 Sets/Book, 3 Books/Pack (66003-3PK)
Item #: 901-24558004
Sales order book is a convenient way to stay organized and track all customer transactions in your business
Size: 4.13" x 7.19"
Each carbonless two-part set features a white top sheet for recording each transaction and a bottom canary yellow sheet that captures written text from the top sheet
$27.99
Per pack
Medical Arts Press Invoices, 8-1/2" x 11", 500 Sets/Book, 500/Pack (30471C)
Item #: 901-30471C
Light Purple Background on Front
Back Is White with Printed Change Of Address & Visa & Mastercard Credit Card Payment Sections
Perforation Is 3.68 From top Of Sheet
$50.99
Per pack
($0.10/EACH)
Custom Purchase Orders, Classic Design, Large Format,3 Parts, 1 Color Printing, 8 1/2" x 11", 500/Pack
Item #: 901-D923
Large-format form lists up to 20 procurement items with plenty of space for terms, requisition numbers, stock & shipping information, plus much more
Signature line prevents unauthorized purchases
Create clean records: Carbonless forms stay tightly aligned for clear, clean copies
Adams Receipts Book, 2.75"L x 5.38"W, 50 Sheets/Book, 3/Pack (DC2501-3)
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
Dome Short-Cut Payroll Book, 8 Columns, 11.25" x 8.75", Navy (650)
Item #: 901-137240
For businesses with 1-50 employees
Double-page spread
Holds records for one year
$31.99
1-2 each
Save 22%
$24.99
3+ each
Adams Write 'N Stick Receipt Book, 2.75" x 5.38", White, 50/Pack (ABF DC2501WS)
Item #: 901-DC2501WS
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
$8.99
1-2 each
Save 6%
$8.49
3+ each
Custom Carbonless Side-Stub Job Work Order, Large Format, 2 Parts, 1 Color Printing, 8 1/2" x 5 1/2", 500/Pack
Item #: 901-D2132
Preprinted areas for material costs, descriptions, labor, signature & dates
Last part is durable tag stock preprinted with a material & labor record for future reference
Consecutive numbering: These forms come with the option to have consecutive numbering printed on them
Adams 3-Part Carbonless Purchase Order, 10.69"L x 8.38"W, 50 Sets/Book (TC8131)
Item #: 901-301648
Keep a bound copy for a permanent record using this purchase order book
Size: 10.69"L x 8.38"W
Features a carbonless 3-part format that allows you to keep a permanent copy for your records
$29.99
Per each
TOPS Credit Card Sales 3-Part Carbonless Receipt, 3.25"L x 7.88"W, 100/Pack (TOP 38538)
Item #: 901-810999
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
$39.99
1-4 pack
Save 5%
$37.99
5+ pack
Purchase Order Book, 2 Parts, Carbonless, 5 1/2" x 7 7/8"
Item #: 901-2675659
In duplicate and triplicate formats
White original, canary duplicate, pink triplicate
50 sets per book
$23.99
Per each
Custom Carbonless Side-Stub Job Work Order, Large Format, 3 Parts, 1 Color Printing, 8 1/2" x 5 1/2", 500/Pack
Item #: 901-D2133
Preprinted areas for material costs, descriptions, labor, signature & dates
Last part is durable tag stock preprinted with a material & labor record for future reference
Consecutive numbering: These forms come with the option to have consecutive numbering printed on them
Tabbies Healthcare Patient Privacy Sign-In Sheets Two-Part Carbon, 11"L x 8.5"W, 125/Pack (14531)
Item #: 901-2678549
Confidentially sign in your patients with patient sign-in label forms
Two-Part patient sign-in label forms
Contains 125 carbon sheets per pack for bulk purchasing
$81.99
Per pack
Medical Arts Press Invoices, 8-1/2" x 11", 500 Sets/Book, 500/Pack (30465A)
Item #: 901-30465A
Solid Color Style D Laser Statements
Size: 8.5 X 11 inch
500/Package
$46.99
1-4 pack
($0.09/EACH)
Save 6%
$43.99
5+ pack
($0.09/EACH)
