Page 21 of replacement superbill forms
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TOPS® Application for Employment, 2-Sided, 8-1/2 x 11", 50 Sheets/Pad, 2 Pads/Box (32851)
Item #: 901-370031
2-hole punched
Application complies with all legal requirements
Includes employment history, references, education, personal information, physical record, check-offs for special questions and space for interviewer's remarks
$40.39
1-3 box
Save 5%
$37.99
4+ box
LUX W-2 / 1099 Envelopes (5 3/4 x 8) 500/Pack, White (7489-W2-500)
Item #: 901-23995918
Comes in White
Dimensions: 5.75"L x 8"W
Moistenable Glue Sealing Method
$166.49
Per pack
ComplyRight™ Employee Records Folder, Letter Size, Pack of 25 (A5001)
Item #: 901-1949184
Made in the U.S.A of thick, long-lasting manila card stock
Developed by Employment Attorneys for 100% Compliance
Easily fits into any filing cabinet or desk drawer
$98.69
1-2 each
Save 8%
$89.99
3+ each
Custom Illness/Injury Excuse Slips, 4" x 5-1/2", 100 Sheets per Pad
Item #: 901-QFN131511R
Excuse forms for injuries and illnesses
4" W x 5-1/2" L
White 20# text stock; printed in black ink
Custom Appointment Excuse Slips, 4" x 5-1/2", 100 Sheets per Pad
Item #: 901-QFN131551R
Excuse forms for appointments
4" W x 5-1/2" L
White 20# text stock; printed in black ink
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
$26.49
Per pack
One-Write PostingIndex Tabs, A-Z, 11x11 (100009N)
Item #: 901-100009
The best choice for basic general expense check writing
Sturdy A-Z metal-tabbed index cards divide ledgers for easy reference
Indexes only
$127.99
Per pack
Adams 2-Part Carbonless Sales Orders, 8.44" x 5.56", 50 Sets/Book (RDC5805)
Item #: 901-843490
Sales order book to maintain precise records
White and canary pages for duplicate copies
One book with 50 sets of forms
$15.89
1-5 each
Save 5%
$14.99
6+ 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
$38.19
1-4 pack
Save 5%
$35.99
5+ pack
Custom Dental Appointment Excuse Slips, 4" x 5-1/2", 100 Sheets per Pad
Item #: 901-QFN131421R
Excuse forms for dental appointments
4" W x 5-1/2" L
White 20# text stock; printed in black ink
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
ComplyRight ADA Self-Seal Envelope (2003ES)
Item #: 901-728692E
Self-Seal Envelope you can use it for 2002, 2004, & 2006 Versions
Dimensions: 9.5" W x 4.125" H
Pack size 500
$133.79
Per box
($0.27/EACH)
Custom Appointment Excuse Slips, 5-1/2" x 8-1/2", 100 Sheets per Pad
Item #: 901-QFN131531R
Excuse forms for work or school
5-1/2" W x 8-1/2" L
White 20# text stock; printed in black ink
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
$52.99
1-3 pack
($0.11/EACH)
Save 9%
$47.99
4+ pack
($0.10/EACH)
Adams® Home and Office Budget Record Journal, Ruled, Blue (AFR31)
Item #: 901-584361
Paper is white and blue in color, and the cover is made of polypropylene
30 sheets featuring 64 forms
Dimensions: 10" x 7"
$17.99
Per each
LUX W-2 / 1099 Envelopes (5 3/4 x 8) 1000/Pack, White (7489-W2-1000)
Item #: 901-23995922
Comes in White
Dimensions: 5.75"L x 8"W
Moistenable Glue Sealing Method
$280.39
Per pack
Custom All-Purpose Excuse Slips, 4" x 5-1/2", 100 Sheets per Pad
Item #: 901-QFN131521R
Excuse forms for work or school
4" W x 5-1/2" L
White 20# text stock; printed in black ink
Rediform 2-Part Carbonless Purchase Requisitions, 4.25"L x 7"W, 50 Sets/Book (1L114)
Item #: 901-421005
Material requisition book is consecutively numbered for easy organization
Business form size: 4.25"L x 7.88"W
Features a carbonless 2-part format that allows you to keep a permanent copy for your records
$20.19
1-9 each
Save 20%
$15.99
10+ each
Medical Arts Press Mounting Sheets; Prescriptions, Adhesive Strip, Two Hole Punched
Item #: 901-20255NP
Keep patient records organized and accessible.
Use for storing duplicates of prescriptions in patient's chart.
Adhesive strips hold up to 10 prescriptions.
$70.09
Per pack
($0.28/EACH)
$12.89
Per each
ComplyRight™ HIPAA Protecting Patient Privacy Poster (A2126)
Item #: 901-728247
Communicates mandatory HIPAA rules to healthcare employees
Educates employees on how and when patient's medical information may be disclosed and what to do if a breach occurs
Poster size 12 x 18"
$37.99
1-4 each
Save 5%
$35.99
5+ 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
Rediform Snap-A-Way 3-Part Carbonless Bill of Lading, 7"L x 8.5"W, 250 Sets/Book (44301)
Item #: 901-421168
Bill of lading provides accurate contractual wording for complete documentation and is punched to allow storage in a post binder
Business form size: 7"L x 8.5"W
3-Part Carbonless forms for accurate record keeping
$78.49
Per pack
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
