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Imprinting Information for New Jersey Prescription Pads
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.
This information will be formatted according to NJ State Requirements.

NEW JERSEY LAW REQUIRES:

• The License Number and NPI# to be printed for each doctor listed.
  
• Only ONE LOCATION may appear on the front of the script.
• We have been notified by the State of New Jersey ....
  All doctor's names MUST be printed on the front of the script.
  The font "point size" can be no smaller than 7pt.
  Thus the imprint format we must use contains:
  The Practice Name, up to THREE (3)doctors names,
  license number, NPI number and (optional) DEA Number,
  address and telephone number.
• Printing additional locations on the back of the script is available
  at an additional charge of $5.00 per pad.
  This charge will be added to the total price of your order.
  
• Additional names MAY NOT be printed on the back of the script.

• Effective 2008 (immediately),
  New Jersey Law requires that all Rx Pads be consecutively numbered