Page 16 of replacement superbill forms
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TFP UB-04 CMS-1450 1-Part Health Insurance Claims, 2500/Carton (UB04LC)
Item #: 901-519727
Designed for hospitals to file a medical claim with the patient's insurance carrier
One-part health insurance forms
Contains 2500 forms per carton
$118.89
Per carton
($0.05/EACH)
ComplyRight Moistenable Glue Security Tinted Double-Window Tax Envelopes, 3 7/8" x 8.5", 50/Pack (3333150)
Item #: 901-24507948
Double-window envelope for W-2 (5210/5211) tax form.
Features a moisture/gum-seal flap.
Pack of 50 envelopes.
$44.59
Per each
TOPS Professional Notebooks, 8.5" x 11", Wide Ruled, 100 Sheets, White (4100)
Item #: 901-459355
50 pages
200 forms, 4 forms per page
Actual book size is 8-1/4" x 11". The detached form size is 5-1/2" x 3-7/8".
$25.49
Per box
Adams 2-Part Carbonless Purchase Requisitions, 8.44"L x 5.56"W, 50 Sets/Book (DC5831)
Item #: 901-DC5831
Keep a bound copy for a permanent record using this purchase requisitions
Business form size: 8.44"L x 5.56"W; detached form size: 5.56"L x 7.94"W
2-Part Carbonless forms for accurate record keeping
$13.79
1-2 each
Save 5%
$12.99
3+ each
Adams 2-Part Carbonless Sales Orders, 5.63"L x 3.34"W, 50 Sets/Book, 10/Pack (DC3510)
Item #: 901-DC3510
General-purpose sales book is ideal for use when receipt or guest check needs to be written
Business form size: 5.63"L x 3.34"W; detached form size: 5.13"L x 3.34"W
2-Part Carbonless forms for accurate record keeping
$25.49
Per pack
($2.55/EACH)
TOPS 3-Part Carbonless Bill of Lading, 11.44"L x 8.5"W, 50 Sets/Book (3846)
Item #: 901-508637
Bill of lading form to ensure all your shipments arrive with the appropriate paperwork
Size: 11.44"L x 8.5"W
Features a carbonless 3-part format that allows you to keep a permanent copy for your records
$37.09
1-3 box
Save 24%
$27.99
4+ box
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
Adams® Carbonless Receipt Book, 3" x 8", 2-Part, 200 Sets/Book (SC1182)
Item #: 901-SC1182
Rent receipt books for recording monthly financial payments
Carbonless paper creates white originals and canary duplicates
Four forms per page and 50 pages; 200 forms per book
$13.89
Per each
TOPS® Proposal Book, Ruled, 2-Part, White/Canary, 11" x 8 3/8", 1/Ea
Item #: 901-2667640
11" x 8 3/8"
50 forms
1 form per page
$15.59
Per each
Adams 2-Part Carbonless Sales Orders, 8.44"L x 5.56"W, 50 Sets/Book (DC5805)
Item #: 901-196113
Sales and order books are ideal for keeping proper records of orders and sales
Business form size: 5.56"W x 8.44"L; detached: 5.56"W x 7.94"L
2-Part White/Canary Carbonless forms for accurate record keeping
$11.19
1-7 each
Save 10%
$9.99
8+ each
TOPS 3-Part Carbonless Bill of Lading, 8.5"L x 7.44"W, 250 Sets/Book, /Box (L3841)
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
$96.59
Per box
Adams 3-Part Carbonless Sales Orders, 10.69"L x 8.38"W, 50 Sets/Book (TC8100)
Item #: 901-301697
Purchase-order books are designed to help you write order and sales memos clearly
Business form size: 10.69"L x 8.38"W; detached form size: 10.19"L x 8.38"W
3-Part Carbonless forms for accurate record keeping
$24.39
Per each
Adams 3-Part Carbonless Auto Repairs, 8.5"L x 7.44"W, 50 Sets/Book (GT3870)
Item #: 901-GT3870
Auto repair order form provides space for all auto service jobs in detail
Business form size: 8.5"L x 7.44"W
3-Part Carbonless forms for accurate record keeping
$21.19
1-4 pack
Save 5%
$19.99
5+ pack
TOPS 2-Part Carbonless Purchase Requisitions, 7.94"L x 5.56"W, 50 Sets/Book (46140)
Item #: 901-377687
Purchase order books are designed to help you write orders memos in a clear manner
Business form size: 7.94"L x 5.56"W; detached form size: 5.56"L x 7.94"W
2-Part Carbonless forms for accurate record keeping
$20.19
Per box
($0.40/EACH)
ComplyRight Notice of Privacy Practice, 100/Pack (A1349)
Item #: 901-398024
Describes how medical information about patients may be used and disclosed
Includes a Tip Sheet in each package that explains the purpose of the form, relevant laws, definitions and do's and don'ts
Size: 8 1/2" x 11"
$35.39
Per pack
TOPS Money/Rent Receipt Book, 5.25" x 11", White/Canary, 50 Sheets/Book (4161)
Item #: 901-745083
Use this receipt book for rent payments or any other type of payment
Original form is white with blue and red ink and canary duplicate with a black/white image
50 pages with four perforated two-part carbonless forms per page
$28.69
Per pad
Adams 3-Part Carbonless Work Orders, 5-2/3" x 9", 250 Sets/Book (3-584)
Item #: 901-442731
Works well for most types of service organizations
5-2/3" x 9"
Space at top for company stamp
$44.59
Per pack
Adams 3-Part Carbonless Sales Orders, 4.19"L x 7.19"W, 50 Sets/Book, 10/Carton (TC4705-10)
Item #: 901-TC470510
Sales and order books are ideal for keeping proper records of orders and sales
Business form size: 7.19"L x 4.19"W
3-Part Carbonless forms for accurate record keeping
$83.79
Per pack
($8.38/EACH)
Ribbon, Printek FormsPro 400, 4mil, Nylon, Black
Item #: 901-919127
For Printek Printers FormsPro 4000, 4003, 4300, 4500, 4503
Matrix Nylon
Impact print technology offers high-quality prints
$32.99
Per each
TOPS 3-Part Carbonless Purchase Requisitions, 5.56"W x 7.94"L, 50 Sets/Book (46141)
Item #: 901-377688
Purchase order books are designed to help you write orders memos in a clear manner
Form size: 5.56"W x 7.94"L
3-Part Carbonless forms for accurate record keeping
$23.39
1-6 each
Save 5%
$21.99
7+ each
Adams 1-Part Carbonless Receipts, 5"L x 3.5"W, 50 Sets/Book, 12 (9672ABF)
Item #: 901-ABF9672
Petty cash receipt pad is designed for cash payouts
Business form size: 5"L x 3.5"W
Single form for ease of use
$21.19
1-3 pack
($1.77/PAD)
Save 19%
$16.99
4+ pack
($1.42/PAD)
Adams 3-Part Carbonless Packing Slips, 7.94"L x 5.56"W, 50 Sets/Book (T5082)
Item #: 901-355859
Packing-slip book is a great way to ensure all shipments contain the correct paperwork
Business-form size: 7.94"L x 5.56"W
3-Part Carbonless forms for accurate record keeping
$12.29
1-7 each
Save 10%
$10.99
8+ each
TOPS 3-Part Carbonless Receiving Records, 5.56"W x 7.94"L, 50 Sets/Book (46260)
Item #: 901-388385
Keep record of all the deliveries you have received with this receiving record book
Form size: 5.56"W x 7.94"L
3-Part Carbonless forms for accurate record keeping
$17.59
Per box
($0.35/EACH)
Adams 2-Part Carbonless Receipt Book, 5" x 11", 200 Sets/Book (SC1152)
Item #: 901-SC1152
Money/rent receipt book for recording rent payments and other payments
White originals and canary duplicates and made of carbonless paper
Contains 200 receipts per book; four forms per page
$12.29
1-4 each
Save 10%
$10.99
5+ each
