California |
ALL CALIFORNIA Rx FORMATS | ||||||
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Item# Rx710 2 part secure prescription
IMPORTANT: click to enlarge
Rx710 Click To Order |
| Item# Rx730 2 part secure prescription
This is the ONLY FORMAT for which we have received an exception. Part Two IS PRINTED Rx730 Click To Order |
2 Part Scripts: Part 1 has distinctive BLUE security background
Part 2 is a BLANK YELLOW sheet ~ 50 sets per pad - padded with wrap around cover
All Prescription Pad Orders MUST BE ENTERED ON LINE We cannot accept orders for prescription pads by Fax. = |
California Prescription Pad Imprinting Information
and your Credit Card Payment Information will be requested
AFTER you have clicked on the "Add to Your SHOPPING CART" button
Due to State of California Regulations ~ Unimprinted forms are not available ~
When Requested,
Please accurately fill-in the information that needs to be imprinted on the top of each sheet.
- By California law, scripts must contain both DEA# and License # for each doctor listed.
- A copy of the DEA Registration for each doctor listed must be sent to us by FAX.
- Under California Law ... ALL California Laser Prescription Paper
MUST BE SHIPPED to the address on file with the DEA
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as required by the State of California | ||||
Order Below
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ITEM# Rx710 Script Size: 5-1/2" x 4-1/4" Imprint up to 4 Names (3 Names plus Facility)
To Order ...
IMPORTANT: |
Rx710 TWO PART SCRIPTS 50 sets per pad with wrap around cover Note: Part 2 is a BLANK YELLOW sheet |
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20 pads ~ $13.25 per pad plus shippingby UPS
40 pads ~ $11.50 per pad plus shipping by UPS
60 pads ~ $10.50 per pad plus shipping by UPS
80 pads ~ $9.00 per pad plus shippingby UPS
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ITEM# Rx720 Oversize - Script Size: 5" x 7" Imprint up to 8 names
To Order ...
IMPORTANT: |
Rx720 TWO PART SCRIPTS 50 sets per pad with wrap around cover Note: Part 2 is a BLANK YELLOW sheet |
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20 pads ~ $22.00 per pad plus shippingby UPS
40 pads ~ $17.75 per pad plus shippingby UPS
60 pads ~ $17.00 per pad plus shipping by UPS
80 pads ~ $15.25 per pad plus shipping by UPS
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ITEM# Rx722 Oversize - Script Size: 5" x 7" Recommend Imprinting up maximum 4 names
To Order ...
IMPORTANT: |
Rx722 TWO PART SCRIPTS 50 sets per pad with wrap around cover Note: Part 2 is a BLANK YELLOW sheet |
20 pads ~ $22.00 per pad plus shipping by UPS
40 pads ~ $17.75 per pad plus shipping by UPS
60 pads ~ $17.00 per pad plus shipping by UPS
80 pads ~ $15.25 per pad plus shipping by UPS
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ITEM# Rx730 Script Size: 8-1/2" x 3-2/3" Imprint up to 9 lines (4 Doctor's Names Maximum) Because of the size of the imprint area, each address will require 2 lines The address on one line; the Phone Number plus Fax Number on the second line.
An example is shown below:
To Order ...
IMPORTANT: |
Rx730 TWO PART SCRIPTS 50 sets per pad with wrap around cover Note: Part 2 is a PRINTED YELLOW sheet with no security features. |
20 pads ~ $16.25 per pad plus shipping by UPS
40 pads ~ $14.25 per pad plus shipping by UPS
80 pads ~ $9.50 per pad plus shipping by UPS
160 pads ~ $8.00 per pad plus shipping by UPS
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California Law requires that a copy of your DEA Registration be sent to us by FAX.
This is a State requirement.
We cannot process any order for which we do not have a current DEA Registration form on file.
Please FAX a copy of your DEA Registration form to
MICRO FORMAT Customer Service
Fax Number: (847)520-0197
Once we receive your DEA Registration Certificate, it will be reviewed along with this order form. After it has been determined that everything is in order, your order will be processed.
Secure GuardTM Single Use Self Expiring Visitor Badges |
Additional Level of Security to your prescriptions with Tamper Evident Security Hologram Labels
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