www.PrescriptionPaper.com
www.RxPaper.com
www.ScriptPaper.com
  • Contact Us
  • About Us
  • HighSecurityPaper.com
  • Secure LASER Prescription Paper - New Jersey Format

    secureORDER FORMsecure
    ~This is a SECURE Order Form ~

    Micro Format, Inc. along with our Manufacturing Partner Printco
    is an approved NJ Pharmacy Board Security Prescription Paper Printer

    Micro Format Imprinted Laser Prescription Paper
    meet all of the requirements legislated by the State of New Jersey.

    All Prescription Pad Orders MUST BE ENTERED ON LINE
    We cannot accept orders for prescription pads by Fax. =


    Imprinting Information for New Jersey Laser Prescription Paper
    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 New Jersey 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.

    VERY IMPORTANT

    New Jersey State Law requires that all Rx Paper Orders are shipped to the address
    on file with the State of New Jersey.

    After submitting your order .....
    the Micro Format Compliance Department requires that you
    send a copy of your State License to our customer service department by FAX
    FAX Number (847)520-0197

    Orders will be processed ONLY after we have received a copy of your State License by fax.
    Failure to send your License will delay the production of your order.
    We appreciate your co-operation with this requirement.



    New Jersey Laser Prescription Forms
    Format #1 (MD,DO,DS,DMD,DPM,DVM)

    Imprint up to 4 Names or 2 Names plus Facility Name
    Each name must be imprinted with License # and NPI #

    ENLARGE VIEW

    Item# NJMD1
    8-1/2" x 11"
    One Script-Top Left
    Script Size 4" x 5-1/2"

    To order ........
    Click On
    "Add to Shopping Cart"


    2,500 sheets
    $435.00 plus shipping
    by UPS

    5,000 sheets
    $650.00 plus shipping
    by UPS

    10,000 sheets
    $1,060.00 plus shipping
    by UPS


    ENLARGE VIEW

    Item# NJMD2
    4" x 11"
    Two Scripts
    Over/Under
    Script Size 4" x 5-1/2"

    To order ........
    Click On
    "Add to Shopping Cart"


    5,000 sheets
    $500.00 plus shipping
    by UPS

    10,000 sheets
    $725.00 plus shipping
    by UPS

    ENLARGE VIEW

    Item# NJMD4
    8" x 11"
    Four Scripts per sheet
    Script Size 4" x 5-1/2"

    To order ........
    Click On
    "Add to Shopping Cart"


    2,500 sheets
    $485.00 plus shipping
    by UPS

    5,000 sheets
    $700.00 plus shipping
    by UPS

    10,000 sheets
    $1,120.00 plus shipping
    by UPS
     
    New Jersey Laser Prescription Forms
    Format #2 (MEDICAL FACILITY)
    Imprint the Facility Name, Address and Phone Number. Only ONE LOCATION may appear
    on the front of the script. One Doctor's Name, NPI# and License Number must appear on script.
    Additional locations may be printed on back of the script
    (at an additional charge).

    ENLARGE VIEW

    Item# NJHC1
    Script Size 4" x 5-1/2"

    8-1/2" x 11"
    One Script-Top Left

    To order ........
    Click On
    "Add to Shopping Cart"


    2,500 sheets
    $435.00 plus shipping
    by UPS

    5,000 sheets
    $650.00 plus shipping
    by UPS

    10,000 sheets
    $1,070.00 plus shipping
    by UPS


    ENLARGE VIEW

    Item# NJHC2
    4" x 11"
    Two Scripts
    Over/Under
    Script Size 4" x 5-1/2"

    To order ........
    Click On
    "Add to Shopping Cart"


    5,000 sheets
    $500.00 plus shipping
    by UPS

    10,000 sheets
    $725.00 plus shipping
    by UPS

    ENLARGE VIEW

    Item# NJHC4
    8" x 11"
    Four Scripts per sheet
    Script Size 4" x 5-1/2"

    To order ........
    Click On
    "Add to Shopping Cart"


    2,500 sheets
    $485.00 plus shipping
    by UPS

    5,000 sheets
    $700.00 plus shipping
    by UPS

    10,000 sheets
    $1,120.00 plus shipping
    by UPS
     
    New Jersey Laser Prescription Forms
    Format #3 (OPTICIAN)
    Imprint maximum 4 Names or 3 Names plus Facility Name.
    Each name must be imprinted with License # and NPI #

    ENLARGE VIEW

    Item# NJOP1
    8-1/2" x 11"
    One Script-Top Left
    Script Size 4" x 5-1/2"

    To order ........
    Click On
    "Add to Shopping Cart"


    2,500 sheets
    $435.00 plus shipping
    by UPS

    5,000 sheets
    $650.00 plus shipping
    by UPS

    10,000 sheets
    $1,070.00 plus shipping
    by UPS


    ENLARGE VIEW

    Item# NJOP2
    4" x 11"
    Two Scripts
    Over/Under
    Script Size 4" x 5-1/2"

    To order ........
    Click On
    "Add to Shopping Cart"


    5,000 sheets
    $500.00 plus shipping
    by UPS

    10,000 sheets
    $725.00 plus shipping
    by UPS

    ENLARGE VIEW

    Item# NJOP4
    8" x 11"
    Four Scripts per sheet
    Script Size 4" x 5-1/2"

    To order ........
    Click On
    "Add to Shopping Cart"


    2,500 sheets
    $485.00 plus shipping
    by UPS

    5,000 sheets
    $700.00 plus shipping
    by UPS

    10,000 sheets
    $1,120.00 plus shipping
    by UPS

    QUESTIONS: Please send us an e-mail
    support@prescriptionpaper.com


    Copyright © 2000-2010 Micro Format, Inc. ~ All Rights Reserved
    Micro Format, Inc.
    830-3 Seton Court ~ Wheeling, IL 60090
    Phone: 847/520-4699 ~ 800-333-0549
    Fax 847/520-0197