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Page 8 of replacement superbill forms

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ComplyRight 2025 1099-R Tax Form, 4-Up, 500/Pack (5175B)ComplyRight 2025 1099-R Tax Form, 4-Up, 500/Pack (5175B)
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ComplyRight 2025 1099-R Tax Form, 4-Up, 500/Pack (5175B)
Item #: 901-24650550
Item #: 901-24650550
Recipient Copy B, C, 2, 2
4-Up (Box style)
Pack of 500 Forms
$65.49
Per each
Add to cart
Earn 65 points
Free delivery
ComplyRight 2025 W-2 Tax Form, 4-Part, 4-Up, 50/Pack (522150)
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ComplyRight 2025 W-2 Tax Form, 4-Part, 4-Up, 50/Pack (522150)
Item #: 901-24507919
Item #: 901-24507919
W-2/1099-R form provides wage and income information to your employees, the SSA, the IRS, and state and local governments
4-Up, 4 Corner W-2 and 1099-R blank, no backer
For laser printers
$44.89
Per each
Add to cart
Earn 44 points
Free delivery
ComplyRight 2025 W-2 Tax Form, 1-Part, 3-Up, Employee Copy B, C, and 2, 50/Pack (521050)ComplyRight 2025 W-2 Tax Form, 1-Part, 3-Up, Employee Copy B, C, and 2, 50/Pack (521050)
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ComplyRight 2025 W-2 Tax Form, 1-Part, 3-Up, Employee Copy B, C, and 2, 50/Pack (521050)
Item #: 901-24507947
(1)
Item #: 901-24507947
Form W-2 provides wage and income information to your employees, the SSA, the IRS, and state and local governments
Single-part, 3-up (horizontal): Employee Copies B, C, and 2 combined
For laser printers
$38.19
Per each
Add to cart
Earn 38 points
Free delivery
ComplyRight 2025 W-2 Tax Form, 1-Part, 2-Up, 50/Pack (520750)
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ComplyRight 2025 W-2 Tax Form, 1-Part, 2-Up, 50/Pack (520750)
Item #: 901-24507938
Item #: 901-24507938
W-2 form provides wage and income information to your employees, the SSA, the IRS, and state and local governments
Single-part 2-up sheet
For laser printers
$31.99
1-3 each
Save 13%
$27.99
4+ each
Add to cart
Earn 31 points
Free delivery
Medical Arts Press® Dental Registration and History Form; Tooth Border, 250 Sheets/Pack (20596)Medical Arts Press® Dental Registration and History Form; Tooth Border, 250 Sheets/Pack (20596)
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Medical Arts Press® Dental Registration and History Form; Tooth Border, 250 Sheets/Pack (20596)
Item #: 901-20596
(4)
Item #: 901-20596
HIPAA compliant insurance authorization
Help ensure reimbursement and improve risk management
Collects printed name and relationship to patient
$57.99
Per pack
($0.23/EACH)
Add to cart
Earn 57 points
Free delivery
ComplyRight 2025 1099-MISC Tax Form, 3-Part, 2-Up, 50/Pack (6102E)
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ComplyRight 2025 1099-MISC Tax Form, 3-Part, 2-Up, 50/Pack (6102E)
Item #: 901-24650569
Item #: 901-24650569
3-Part Set: Copy A, B, State/File (25 sheets each), transmittals (3) and Self-Seal Envelopes (50)
2-Up: 2 Forms per Sheet
For 50 Employees
$65.99
Per each
Add to cart
Earn 65 points
Free delivery
Quill Brand® Aluminum Clipboard, Legal, Silver, 8.5 x 14, 1/PKQuill Brand® Aluminum Clipboard, Legal, Silver, 8.5 x 14, 1/PK
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Quill Brand® Aluminum Clipboard, Legal, Silver, 8.5" x 14", 1/PK
Item #: 901-1828053
(2)
Item #: 901-1828053
Storage clipboard protects and organizes your business forms and documents
Legal sized aluminum clipboard
Low-profile steel clip
$57.99
Per each
Add to cart
Earn 57 points
Free delivery
Adams Gummed Double Window 1095 B&C Tax Form Envelopes, 5-5/8 x 9, White, 100/Pack (DW1095BC18-S)
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Adams Gummed Double Window 1095 B&C Tax Form Envelopes, 5-5/8" x 9", White, 100/Pack (DW1095BC18-S)
Item #: 901-DW1095BC18
Item #: 901-DW1095BC18
Double Window Security Envelopes - 5-5/8" x 9"
For 1095B and 1095C ACA Tax Forms
Top Window - 3-7/16" x 1", Bottom Window - 3-7/16" x 3/4"
$65.99
Per pack
($0.66/Envelope)
Add to cart
Earn 65 points
Free delivery
ComplyRight 2025 W-2 Tax Form, 1-Part, 4-Up, 500/Pack (5209B)ComplyRight 2025 W-2 Tax Form, 1-Part, 4-Up, 500/Pack (5209B)
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ComplyRight 2025 W-2 Tax Form, 1-Part, 4-Up, 500/Pack (5209B)
Item #: 901-24461397
(1)
Item #: 901-24461397
W-2 employee four-up box blank with backer cut sheet
Single-part four-up box blank
For laser printers
$143.39
Per each
Add to cart
Earn 143 points
Free delivery
ComplyRight Double Window Envelope for Tax Form, 5.63 x 9, White/Black, 100/Pack (51511)ComplyRight Double Window Envelope for Tax Form, 5.63 x 9, White/Black, 100/Pack (51511)
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ComplyRight Double Window Envelope for Tax Form, 5.63" x 9", White/Black, 100/Pack (51511)
Item #: 901-24578186
(1)
Item #: 901-24578186
Simple high-quality double-window envelope for W-2 (5218) tax form that gets the job done
Dimensions: 5.63" x 9"
Comes in white with black text
$47.99
1-4 each
Save 15%
$40.99
5+ each
Add to cart
Earn 47 points
Free delivery
Medical Arts Press® Chiropractic Registration and History Form, 250 Forms/Pack (21701)Medical Arts Press® Chiropractic Registration and History Form, 250 Forms/Pack (21701)
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Medical Arts Press® Chiropractic Registration and History Form, 250 Forms/Pack (21701)
Item #: 901-21701
(2)
Item #: 901-21701
Forms ensure reimbursement, improve risk management and document your clinical process
Comprehensive color forms include areas for complete registration and history information, reason for visit, type of pain, site of pain or numbness
Also features areas for severity, onset, effect on daily activities, and co
$67.99
Per pack
($0.27/EACH)
Add to cart
Earn 67 points
Free delivery
Price drop
Cosco Patient Confidential Sign-In Forms, 3-Part, 125 Forms/Pack (074043)Cosco Patient Confidential Sign-In Forms, 3-Part, 125 Forms/Pack (074043)
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Cosco Patient Confidential Sign-In Forms, 3-Part, 125 Forms/Pack (074043)
Item #: 901-24617597
(2)
Item #: 901-24617597
Patient Sign-In Label forms to sign in your patients confidentially
HIPAA Compliant
125 Sheets Per Package
$68.99
1-5 pack
Save 10%
$61.99
6+ pack
Add to cart
Earn 68 points
Free delivery
Price drop
Cosco Patient Bilingual Confidential Sign-In Forms, 3-Part, 125 Forms/Pack (074042)Cosco Patient Bilingual Confidential Sign-In Forms, 3-Part, 125 Forms/Pack (074042)
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Cosco Patient Bilingual Confidential Sign-In Forms, 3-Part, 125 Forms/Pack (074042)
Item #: 901-24617599
(3)
Item #: 901-24617599
Patient Bilingual Sign-In Label forms to sign in your patients confidentially
HIPAA Compliant
125 Sheets Per Package
$68.99
Per pack
Add to cart
Earn 68 points
Free delivery
Medical Arts Press® Dental Registration and History Form; Purple and Teal DesignMedical Arts Press® Dental Registration and History Form; Purple and Teal Design
Quick view
Medical Arts Press® Dental Registration and History Form; Purple and Teal Design
Item #: 901-20579
Item #: 901-20579
$18.19
Per pack
($0.07/EACH)
Add to cart
Earn 18 points
Free delivery w/ $25+
Cosco Patient Confidential Sign-In Forms, 3-Part, 125 Forms/Pack (074041)Cosco Patient Confidential Sign-In Forms, 3-Part, 125 Forms/Pack (074041)
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Cosco Patient Confidential Sign-In Forms, 3-Part, 125 Forms/Pack (074041)
Item #: 901-24617598
(2)
Item #: 901-24617598
Patient Sign-In Label forms to sign in your patients confidentially
HIPAA Compliant
125 Sheets Per Package
$68.99
Per pack
Add to cart
Earn 68 points
Free delivery
Price drop
Cosco Patient Confidential Sign-In Forms, 3-Part, 125 Forms/Pack (074039)Cosco Patient Confidential Sign-In Forms, 3-Part, 125 Forms/Pack (074039)
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Cosco Patient Confidential Sign-In Forms, 3-Part, 125 Forms/Pack (074039)
Item #: 901-24617595
(2)
Item #: 901-24617595
Patient Sign-In Label forms to sign in your patients confidentially
HIPAA Compliant
125 Sheets Per Package
$68.99
1-9 pack
Save 9%
$62.99
10+ pack
Add to cart
Earn 68 points
Free delivery
ComplyRight 2024 ADA Dental Claim Forms, 500 Forms/Pack (20241500)ComplyRight 2024 ADA Dental Claim Forms, 500 Forms/Pack (20241500)
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ComplyRight 2024 ADA Dental Claim Forms, 500 Forms/Pack (20241500)
Item #: 901-24602228
Item #: 901-24602228
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
$45.99
1-2 each
Save 7%
$42.99
3+ each
Add to cart
Earn 45 points
Free delivery
ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5)
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ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5)
Item #: 901-24614845
Item #: 901-24614845
Designed for hospitals to file a medical claim with the patient's insurance carrier
One-part health insurance forms
Printed with OCR dropout red ink on white paper
$41.99
Per each
Add to cart
Earn 41 points
Free delivery
ComplyRight 2024 ADA Dental Claim Forms, 2,500 Forms/Pack (20241)ComplyRight 2024 ADA Dental Claim Forms, 2,500 Forms/Pack (20241)
Quick view
ComplyRight 2024 ADA Dental Claim Forms, 2,500 Forms/Pack (20241)
Item #: 901-24602226
Item #: 901-24602226
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
$125.99
Per each
Add to cart
Earn 125 points
Free delivery
ComplyRight 2024 ADA Dental Claim Forms, 100 Forms/Pack (20241100)ComplyRight 2024 ADA Dental Claim Forms, 100 Forms/Pack (20241100)
Quick view
ComplyRight 2024 ADA Dental Claim Forms, 100 Forms/Pack (20241100)
Item #: 901-24602229
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
$15.99
Per each
Add to cart
Earn 15 points
Free delivery w/ $25+
ComplyRight CMS-1500 Health Insurance Claims, 2500/Pack (CMS12LC)ComplyRight CMS-1500 Health Insurance Claims, 2500/Pack (CMS12LC)
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ComplyRight CMS-1500 Health Insurance Claims, 2500/Pack (CMS12LC)
Item #: 901-125557
(58)
Item #: 901-125557
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
$123.99
Per pack
($0.05/EACH)
Add to cart
Earn 123 points
Free delivery
Custom Florist Register Form, Classic Design, Large Format, TAX. DEL., 3 Parts, 1 Color Printing, 5 1/2 x 8 1/2, 500/Pack
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Custom Florist Register Form, Classic Design, Large Format, TAX. DEL., 3 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-D6723B
Item #: 901-D6723B
Pricing details
Multiple layout options: Choice of different layouts for tax and delivery options - Layout A: Del, Tax, Layout B: Tax, Del, Layout C: Blank, Layout D: Tax
Compatible with our registers
Additional customization options include imprinting your custom logo
$260.99
1 pack
($0.52/EACH)
Save 42%
$151.99
12 pack
($0.30/EACH)
Customize
Earn 260 points
Free delivery
Custom Florist Register Form, Classic Design, Large Format, TAX. DEL., 2 Parts, 1 Color Printing, 5 1/2 x 8 1/2, 500/Pack
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Custom Florist Register Form, Classic Design, Large Format, TAX. DEL., 2 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-D6722B
Item #: 901-D6722B
Pricing details
Multiple layout options: Choice of different layouts for tax and delivery options - Layout A: Del, Tax, Layout B: Tax, Del, Layout C: Blank, Layout D: Tax
Compatible with our registers
Additional customization options include imprinting your custom logo
$209.99
1 pack
($0.42/EACH)
Save 48%
$108.99
12 pack
($0.22/EACH)
Customize
Earn 209 points
Free delivery
Out of stock
Adams Gummed Double Window Envelope for Tax Form, 5 5/8 x 9, White, 100/Pack (DW4ALT100)Adams Gummed Double Window Envelope for Tax Form, 5 5/8 x 9, White, 100/Pack (DW4ALT100)
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Adams Gummed Double Window Envelope for Tax Form, 5 5/8" x 9", White, 100/Pack (DW4ALT100)
Item #: 901-99991
(28)
Item #: 901-99991
Tax Envelopes are easy close, tinted for 100% security and are double-windowed
Use with LW24UPALT tax form
24-lb. white wove stock
$44.59
1-5 pack
($0.45/EACH)
Save 6%
$41.99
6+ pack
($0.42/EACH)
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Earn 44 points
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