Page 2 of replacement superbill forms
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ComplyRight 2025 W-2 Blank Tax Form, 4-Up (Horizontal), with Backer Instructions, Pack of 500 Forms
Item #: 901-24650554
Form W-2 provides wage and income information to your employees, the SSA, the IRS, and state and local governments
Single-part, blank tax form
For laser printers
$92.99
Per each
ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Box of 1,000 (CMS12LC1)
Item #: 901-CMS12LC1
Includes QR code identifier at the top of the form that supports and aligns with Industry scanning systems
Printed with OCR "dropout" red ink on 20lb. paper (per government regulations)
Includes new QR code identifier at the top of the form that supports and aligns with Industry scanning systems
$80.59
Per carton
($0.08/EACH)
ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Pack of 500 (CMS12LC500)
Item #: 901-CMS12LC500
Includes QR code identifier at the top of the form that supports and aligns with Industry scanning systems
Printed with OCR "dropout" red ink on 20lb. paper (per government regulations)
Includes new QR code identifier at the top of the form that supports and aligns with Industry scanning systems
$49.99
Per pack
($0.10/EACH)
TOPS Centers for Medicare and Medicaid Services Forms, 8-1/2" x 11", 250/Pack (50135RV)
Item #: 901-2408453
CMS-1500 claim forms (formerly known as HCFA-1500 claim forms) expedite Medicare, Medicaid or private insurance benefits
Top sensor bar for microfiche duplication, as required in some states
OCR red ink for scanning
$35.09
Per pack
($0.14/EACH)
ComplyRight 2025 1096 Tax Form, 1-Part, Transmittal, 10/Pack (510010)
Item #: 901-24507945
Use form 1096 to submit the totals from information returns to the Internal Revenue Service.
Transmittal Form
1 Page Equals 1 Form
$15.49
1-3 each
Save 9%
$13.99
4+ each
ComplyRight 2025 1096 Tax Form, 1-Part, Transmittal, 25/Pack (510025)
Item #: 901-24507927
Use form 1096 to submit the totals from information returns to the Internal Revenue Service.
Transmittal Form
1 Page Equals 1 Form
$32.89
1-4 each
Save 14%
$27.99
5+ each
Medical Arts Press Registration Forms without Updates Section ; Brush Silhouette
Item #: 901-21786
Comprehensive form gathers complete insurance information, making it easier for you to process claims
Silhouetted toothbrush design welcomes patients
Printed in 1-color on two sides on 24-lb. white bond paper
$56.29
Per pack
($0.23/EACH)
Medical Arts Press Dental Registration and History Form, 250/Pack (20605)
Item #: 901-20605
Form allows you to gather complete information from patients
Simple to fill out with individually numbered sections
Includes sections on patient information, insurance, history and more
$52.99
Per pack
($0.21/EACH)
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
ComplyRight 2025 1099-NEC Tax Form 25 self-seal envelopes, 4-Part, 3-Up, Copy A, B, C/2, 1096 Transmittal, 25/Pack (NEC6103E25)
Item #: 901-24578199
1099-NEC (nonemployee compensation) is an IRS form created for companies to report payments made to an individual who performed services in the course of business as a nonemployee
Includes four-part tax forms
3-Up forms: three forms on a single sheet
$42.89
1-4 each
Save 23%
$32.99
5+ each
Medical Arts Press Dental Registration Forms, 250/Pack (20558)
Item #: 901-20558NP
Type of form: Dental registration form
250 per pack
Size: 8 1/2" x 11"
$60.49
Per pack
($0.24/EACH)
ComplyRight 2025 1099-MISC Tax Form, 4-Part, Copy A, C, B, 50/Pack (95914E)
Item #: 901-24431084
1099-MISC tax form for payments, such as miscellaneous income made in the course of a trade or business
Pre-packaged four-part form set contains copies A, B, C, "Copy 2", with envelopes and three 1096 transmittal forms
Compatible with laser printer
$56.29
Per each
ComplyRight 2025 1099-NEC Tax Form, 4-Part, 3-Up, Copy A, B, C/2, 1096 Transmittal, 100/Pack (NEC6103100)
Item #: 901-24578197
1099-NEC (nonemployee compensation) is an IRS form created for companies to report payments made to an individual who performed services in the course of business as a nonemployee
Includes four-part tax forms
3-Up forms: three forms on a single sheet
$66.89
1-4 each
Save 16%
$55.99
5+ each
ComplyRight 2025 1099-MISC Tax Form, 1-Part, 2-Up, Federal Copy A, 25/Pack (511025)
Item #: 901-24431083
1099-MISC tax form for payments, such as miscellaneous income made in the course of a trade or business
2-Up Federal Copy A tax forms
Single part
$35.09
1-3 each
Save 5%
$32.99
4+ each
ComplyRight 2025 W-3 Tax Form, 1-Part, Transmittal, 10/Pack (520010)
Item #: 901-24507958
W-3 summary transmittal form is used to report total annual earnings, Social Security wages, Medicare wages, and withholding for all your employees to the Social Security Administration.
Transmittal Form
1 Page Equals 1 Form
$11.59
1-3 each
Save 5%
$10.99
4+ each
ComplyRight 2025 W-2 Tax Form, 4-Part, 2-Up, 50/Pack (95214E)
Item #: 901-24431085
Form W-2 and transmittal form W-3 for reporting wages and tax statements
Pre-packaged four-part form set includes copies A, B, C, D
For laser printers
$98.69
1-3 each
Save 24%
$74.99
4+ each
ComplyRight 2025 W-2 Tax Form, 6-Part, 2-Up, 25/Pack (5650E25)
Item #: 901-24650568
Form W-2 and transmittal Form W-3 for reporting wages and tax statements
6-Part Set Includes: Copy A, B, C, 2, D, 1 (13 Sheets each) 3 Transmittals and 25 Self-Seal Envelopes
2-Up: 2 Forms per Sheet
$44.99
Per each
ComplyRight 2025 1099-NEC Tax Form Envelopes, 4-Part, 3-Up, Copy A, B, C/2, 1096 Transmittal, 100/Pack (NEC6103E100)
Item #: 901-24578201
1099-NEC tax form set is created for companies to report payments made to an individual who performed services in the course of business as a nonemployee
Consists of four parts
3-up page format: three forms on a single sheet
$57.29
Per each
ComplyRight 2025 W-2 Tax Form Set with Self-Seal Envelopes, 4-Part, 2-Up, For 50 Employees
Item #: 901-24650565
Form W-2 and transmittal Form W-3 for reporting wages and tax statements
4-Part Set Includes: Copy A, B, C, D (25 Sheets each) 3 Transmittals and 50 Self-Seal envelopes
2-Up: 2 Forms per Sheet
$51.99
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)
ComplyRight 2025 1099-MISC Tax Form, 4-Part, 2-Up, Copy A, B, C/2, 1096 Transmittal, 100/Pack (6103100)
Item #: 901-24578191
Use the 1099-MISC form to report payments made in the course of your business for each person to whom you paid at least 10 dollars in royalties or at least 600 dollars in rents, prizes, or awards
Includes four-part tax forms
2-Up forms: two forms on a single sheet
$67.89
1-2 each
Save 17%
$55.99
3+ each
ComplyRight 2025 1099-NEC Tax Form 50 self-seal envelopes, 4-Part, 3-Up, Copy A, B, C/2, 1096 Transmittal, 50/Pack (NEC6103E)
Item #: 901-24578200
1099-NEC (nonemployee compensation) is an IRS form created for companies to report payments made to an individual who performed services in the course of business as a nonemployee
Includes four-part tax forms
3-Up forms: three forms on a single sheet
$51.99
Per each
ComplyRight 2025 W-2 Tax Form, 1-Part, 4-Up, Employee Copy B, C, and 2, 50/Pack (520550)
Item #: 901-24507926
Form W-2 provides wage and income information to your employees, the SSA, the IRS, and state and local governments
Single-part, 4-up sheet (box format): Employee Copies B, C, 2, and 2 combined
For laser printers
$32.89
Per each
ComplyRight 2025 1099-NEC Tax Form, 3-Up, 75/Pack (NEC515950)
Item #: 901-24650572
Copy B and Backer with Stub
3-Up: 3 Forms per Sheet
Pack of 75 Forms
$5.99
Per each
