Page 5 of proposal 8 1 2x11 carbonless triplicate 50 loose form sets
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Quill Brand® 9.5" x 11" Continuous Form Paper, 20 lbs., 92 Brightness 2550 Sheets/Carton (710657)
Item #: 901-710657
Continuous form bond paper
Paper weight: 20 lbs.
Size: 9-1/2x11" (8-1/2" width with carrier strips removed)
$122.39
Per carton
Custom Welcome Registration and History Forms, 8-1/2" x 11", 250 Sheets per Pack
Item #: 901-QFN117541R
For use in patient charts
8-1/2" W x 11" L
White 20# text stock; printed in burgandy ink
Adams Last Will & Testament, Forms & Instructions (LF235/ALFP117)
Item #: 901-571355
Last Will & Testament details your assets and the beneficiaries who will receive them
Form size: 11"L x 8.5"W
Comes in white
$10.59
Per each
ComplyRight 2024 ADA Dental Claim Forms, 100 Forms/Pack (20241100)
Item #: 901-24602229
Forms conform to the Health Insurance Portability and Accountability Act (HIPAA)
Forms provide a common format for reporting dental services to a patient's dental benefit plan
ADA policy promotes use and acceptance latest version ADA Dental Claim Forms by dentists and payers
$14.89
Per each
ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250)
Item #: 901-CMS12LC250
Approved by the National Uniform Claim Committee (NUCC); HIPAA compliant
This form was revised to align the paper form with some of the changes in the electronic healthcare claims: Professional (837), 005010X222 Technical Report Type 3 (5010) and 005010X222A1 Technical Report Type 3 (5010A1)
The most significant change was the addition of 8 diagnosis codes in field 21
$43.59
Per box
($0.17/EACH)
Custom Carbonless Veterinarian Surgical Consent Form, 5-1/2" x 8-1/2", 100 Sets per Pad
Item #: 901-QFW1302901
Self-duplicating; everything is printed on original and duplicate
5-1/2" W x 8-1/2" L
White self-duplicating carbonless stock; pre-printed in black ink
TOPS 2-Part Money/Rent Receipt Book, 5.37" x 2.75", White, 50 Forms (46820)
Item #: 901-745091
5 3/8" x 2 3/4"
50 ruled forms
1 form per page
$10.59
1-6 each
Save 5%
$9.99
7+ each
TOPS CMS-1500 Health Insurance Claims, 500/Pack (TOP 50126RV)
Item #: 901-309934
Satisfy record keeping requirements with these health insurance claim forms
Number of parts: 1
Contains 500 forms per package
$73.19
Per pack
ComplyRight HIPAA Patient Consent and Authorization Form (A1350)
Item #: 901-398021
Attorney approved form acknowledging patient's consent to release his or her protected health information to an authorized third party
Complies with HIPAA’s authorization requirements
Size: 8 1/2" x 11"
$66.89
Per pack
Quill Brand® 14-7/8 "x 11" Continuous Form 1/2" Blue Bar Paper, 20 lbs., 2700 Sheets/Carton (QU710604)
Item #: 901-710604
1/2" blue bar Bond paper for continuous form printing
Paper weight: 20 lbs.
Size 14-7/8x11"
$196.39
Per carton
($0.07/EACH)
ComplyRight 2025 Time Off Request and Approval Form, 2-Part, 50 Forms/Pack (A0045)
Item #: 901-24202398
Calendar format makes it easy for employees to select and submit time off requests
Ensures a consistent request and approval process for all employees
Attorney-approved to ensure 100% compliance
$97.69
1-4 each
Save 17%
$80.99
5+ each
Adams® Job Invoice Form, Ruled, 8" x 11", 2-Part, White, 100 Sheets/Pack (NC2817)
Item #: 901-468769
Carbonless job invoice sets for service industries
Dimensions: 8.5" x 11.44" x 1.1"
White original to copy and white duplicate with blue text
$14.89
Per each
Medical Arts Press® Physical Exam Forms, Green FormFamily™, Top Punched, 250/PK
Item #: 901-20379
Type of form: Physical exam form
250 per pack
Size: 8 1/2" x 11"
$54.19
1 pack
($0.22/EACH)
Save 13%
$46.99
2+ pack
($0.19/EACH)
Quill Brand® 20-lb. Bond Continuous Form Paper, 9-1/2x11", 1000/Ctn.
Item #: 901-710761
Reliable business paper is perfect for business use
Paper dimensions: 9.5"W x 11"L
Paper weight: 20 lbs.
$46.99
Per carton
($0.05/EACH)
Custom 2-Part Snapset CMS Forms, 8-1/2" x 11", 500 Sets per Pack
Item #: 901-QFW1471701
Snapset form for use by all medical facilities for billing insurance companies, Medicaid and Medicare; aligned with the electronic HIPAA ASC X12N 837 Non-institutional Transaction Standard
8-1/2" W x 11" L
2-part, white/canary, carbonless
Quill Brand® 1-Part Continuous Form Bond Paper, 14-7/8x11", 18-lb.
Item #: 901-710601
Business computer paper is excellent for making carbonless copies
Paper dimensions: 14.875"W x 11"L
Paper weight: 18 lbs.
$122.39
Per carton
Adams Living Will & Health Care POA Forms and Instructions Kit, 11.69" x 8.88" (ABF K306)
Item #: 901-572455
These forms are simple to use, easy to understand, and a great way to express your choice of when to discontinue treatment and life support
White primary page coloring with black ink on the form
Contains forms and instructions with carbon duplicate and their digital copies on a CD
$18.89
1-2 each
Save 10%
$16.99
3+ each
Custom 2-Sided Dental Registration and History Forms, 8-1/2" x 11", 250 Sheets per Pack
Item #: 901-QFN105121R
For use in patient charts
8-1/2" W x 11" L
White 20# text stock; printed in black ink
Custom Multi-Purpose Register Form, Classic Design, Small Format, ALL SALES FINAL, 3 Parts, 1 Color Printing, 4" x 6", 500/Pack
Item #: 901-D609SW3A
Multiple layout options: Available in your choice of 3 layouts of special wording - Layout A: All Sales Final, Layout B: No Cash Returns, Layout C: Custom Message
Compatible with our registers
Consecutive numbering: These forms come with the option to have consecutive numbering printed on them
NAHANCO Men's Half Round Display Form, Black, 1 Each
Item #: 901-216469NAH
12/pack
Dimensions: 7"(Deep), 35 x 20 x 6
Style: Torso
$39.99
Per each
Custom Multi-Purpose Register Form, Spectra Design, Large Format, 3 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-DSP1263
Compatible with our register holders
These forms come with the option to have consecutive numbering printed on them
Additional customization options include imprinting your custom logo
Medical Arts Press® Progress Notes; Purple FormFamily™
Item #: 901-20643
Record detailed chronological notes for ongoing patient care pertaining to illnesses, treatments, and progress
Printed in blue ink on white 24-lb. bond paper
2 Predrilled holes on top and 5 on the side
$54.19
1-3 pack
($0.22/EACH)
Save 20%
$42.99
4+ pack
($0.17/EACH)
Custom Multi-Purpose Register Form, Classic Design, Large Format, 4 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-D6104
Use with your portable register to capture details on the spot - no hunting for a handy place to write
Preprinted areas simplify write-ups of customer information, salesperson, description of items, payment method & more
Compatible with 5 1/2 x 8 1/2" portable registers, sold separately
Custom Locksmith Register Form, Classic Design, Small Format, 3 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-D6193
Compatible with our register holders
Detailed form: Has section to get authorization for security and emergency service
Survey on back: Home security survey on back lets you note security concerns for your customers