Page 22 of hcfa cms 1500 health insurance business forms
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TOPS™ Gift Certificate Book, 1-Part, 25/Book (GFTBK1)
Item #: 901-448269
Gift Certificate book to personalize your gift
Dimensions: 0.13"H x 3.25"W x 11"L, 7.81" x 3.25" (detached form), 11" x 3.25" (sheet)
Color: Cream (primary page), maroon (ink)
$9.99
Per each
Rediform 2-Part Carbonless Driver's Daily Logs, 9.13"L x 5.5"W, 31 Sets/Book (REDS5031NCL)
Item #: 901-REDS5031NC
Driver's daily log book is providing plenty of space to record driving time
Size: 9.13"L x 5.5"W
Features 2-part format that allows you to keep a permanent copy for your records
$13.99
1-10 each
Save 7%
$12.99
11+ each
Adams Carbon Rental Applications, 8.5" x 11", (LF255)
Item #: 901-571368
The easy-to-use, month-to-month rental agreement form allows you to lease residential property on a monthly basis, specifying all terms and conditions from security deposits to late charges
Form size: 11"L x 8.5"W
Form duplicate: carbon; comes in white
$12.99
Per each
Medical Arts Press Invoices, 8-1/2" x 11", 500 Sets/Book, 508/Pack (19906C)
Item #: 901-19906C
Perforation Is 3-11/16 From top Of Statement
Back Print Includes Area For Updating Patient Information to Help Keep Files Current
Size: 8.5 x 11 inch
$54.99
1-3 pack
($0.11/EACH)
Save 9%
$49.99
4+ pack
($0.10/EACH)
$13.99
Per each
Adams 2-Part Carbonless Sales Orders, 7.19"L x 3.34"W, 50 Sets/Book (DC3705)
Item #: 901-DC3705
Sales and order books are ideal for keeping proper records of orders and sales
Size: 7.19"L x 3.34"W
Features a carbonless 2-part format that allows you to keep a permanent copy for your records
$18.99
Per each
ComplyRight Self-Seal Tax Envelope, 10" x 13", White/Green, 50/Pack (PEB02)
Item #: 901-24588696
Double-window multipurpose tax return envelope will dress up every tax return and report from your office
Dimensions: 10" x 13"
Made of paper in white with green accents
$59.99
Per each
Adams 2-Part Carbonless Invoices, 8-1/2" x 7-7/16", 50 Sets/Book (NC2872-50)
Item #: 901-442798
2-part carbonless with a white, canary paper sequence
Ruled format
Space at top for company stamp
$34.99
Per pack
Custom Purchase Orders - Classic Small Booked,3 Parts, 1 Color Printing, 8 1/2" x 7", 250/Pack
Item #: 901-D91B3
Keep track of everything you buy! Professional Purchase Orders have preprinted columns and room to list quantities, stock numbers, descriptions and more
Signature line prevents unauthorized purchases
Create clean records: Carbonless forms stay tightly aligned for clear, clean copies
Custom Bill of Lading, Carbonless, Small Format, 3 Parts, 1 Color Printing, 8 1/2" x 7", 500/Pack
Item #: 901-D50413
Special section to identify hazardous materials
Carbonless forms for clean copies
7 description lines
TOPS Credit Card Sales 3-Part Carbonless Receipts, 3.25"L x 7.88"W, 100 Sets/Book, 5/Carton (38538CT)
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
TOPS 2-Part Carbonless Purchase Requisitions, 10.69"L x 8.38"W, 50 Sets/Book (46146)
Item #: 901-388373
Purchase order books are designed to help you write order memos in a clear manner
Business form size: 10.69"L x 8.38"W; detached form size: 10.19"L x 8.38"W
Features a carbonless 2-part format that allows you to keep a permanent copy for your records
$20.99
Per each
ComplyRight Self Seal Security Tinted Double-Window Tax Envelopes, 5 5/8" x 9.25", 25/Pack (6666225)
Item #: 901-24507914
Double-window envelope for 2-Up W-2 tax form.
Self-sealing for added convenience.
Pack of 25 envelopes.
$39.29
Per each
Custom Contractor Invoice - Itemized Invoice for Large Jobs, 3 Parts, 1 Color Printing, 8 1/2" X 11" ,500/Pack
Item #: 901-D2093
Consecutively numbered for easy recordkeeping
Promote your business: Personalization includes your imprint plus choice of typeface and standard logo or custom logo
Imprint Color: Black
Adams Employment Applications, 50/Pad, 2 Pads/Pack (ABF 9661)
Item #: 901-9661
Includes the necessary information for every type of position
Contains 50 two-sided forms per pad, two pads per package
Perfect contrast of blue ink on white paper
$31.99
Per pack
($16.00/PAD)
Custom Cash Receipt Books, Classic Design, 3 To Page, 2 Parts, 1 Color Printing, 6 3/4" x 8 1/2", 500/Pack
Item #: 901-D6932
Simple: An easy way to track payments
Get the details: Receipt form features preprinted areas that document payment, payment method & account balance
Stay organized: Bottom copy stays bound in book for a permanent record
Rediform 3-Part Carbonless Credit Memos, 5.5"L x 7.88"W, 50 Sets/Book (RED7L787)
Item #: 901-508632
Credit memo book is consecutively numbered for easy organization
Credit memo book has a flexible cover
Envelopes are not included
$23.99
Per each
Custom Bills of Lading - Small Carbonless, 3 Parts, 1 Color Printing, 8 1/2" x 7", 250/Pack
Item #: 901-D62053
Meets regulations. These forms meet all D.O.T. and I.C.C. regulations. Please note: For Non-Hazmat shipments only
Get the details: 6 description lines
Consecutively numbered for easy recordkeeping
Custom Bill of Lading - Large Carbonless, 3 Parts, 1 Color Printing, 8 1/2" X 11" ,250/Pack
Item #: 901-D62253
Meets regulations: These forms meet all D.O.T. and I.C.C. regulations
Generous description area: 17 description lines
Identify hazardous materials. Special section to identify hazardous materials
TOPS® Bill of Lading Unit Set, Ruled, 4-Part Carbonless, 11-7/16" x 8-1/2", 50/Pack (3847)
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
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
TOPS Snap-Off 3-Part Carbonless Packing Slips, 8-1/2" x 7", 50 Sets/Book (3834)
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
Medical Arts Press Invoices, 8-1/2" x 11", 500 Sets/Book, 500/Pack (33176D)
Item #: 901-33176D
Credit card alert helps speed payment - VISA and MasterCard only
Includes patient update
Easy-tear perforation is 3-11/16" from top for removal of white payment stub
$50.99
1-3 pack
($0.10/EACH)
Save 6%
$47.99
4+ pack
($0.10/EACH)
Solid Color Laser Statements, Style B, with Credit Card Information, Blue
Item #: 901-33176A
Credit Card Alert Helps Speed Payment - Visa & Mastercard only
Includes Patient Update
Easy-Tear Perforation Is 3.68" From top for Removal Of White Payment Stub
$46.99
Per pack
($0.09/EACH)
