IMPORTANT State of New Jersey INFORMATION
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
| VERY IMPORTANT
New Jersey State Law requires that all Rx Pads 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.
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Copyright © 2008 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
