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. NOTICE WITHOUT EXCEPTION, Your order WILL NOT BE PROCESSED until your License has been received. It is for your protection. We appreciate your co-operation with this requirement.

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Available Formats
Format 1 (MD, DO, DS, DMD, DPM, DVM) click to enlarge	Format 2 (Facility Format) click to enlarge	Format 3 (Optometrist Format)   click to enlarge	Format 4 (Nurse Practitioner) click to enlarge	Format 5 (Physician Assistant) click to enlarge
PC41-NJ Click To Order 1 part pads	PC42-NJ Click To Order 1 part pads	PC43-NJ Click To Order 1 part pads	PC44-NJ Click To Order 1 part pads	PC48-NJ Click To Order 1 part pads

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Please Read ~ Important New Jersey Requirements
Order 1 part pads Below
ITEM# Format 1 (MD, DO, DS, DMD, DPM, DVM) Script Size: 4" x 5-1/2" Imprint up to 4 Names or 2 Names plus Facility Name Each name must be imprinted with License # and NPI # click to enlarge To Order ... click on the "Add to Your SHOPPING CART" button.	PC41-NJ (MD, DO, DS, DMD, DPM, DVM) ONE PART SCRIPTS 100 sheets per pad
	20 pads ~ $7.55 per pad plus shippingby UPS 40 pads ~ $5.75 per pad plus shipping by UPS 80 pads ~ $5.05 per pad plus shipping by UPS 160 pads ~ $4.85 per pad plus shipping by UPS
ITEM# Format2 (Facility Format) Script Size: 4" x 5-1/2" click to enlarge 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). To Order ... click on the "Add to Your SHOPPING CART" button.	PC42-NJ (Facility Format) PC42-NJ ONE PART SCRIPTS 100 sheets per pad
	20 pads ~ $7.55 per pad plus shippingby UPS 40 pads ~ $5.75 per pad plus shipping by UPS 80 pads ~ $5.05 per pad plus shippingby UPS 160 pads ~ $4.85 per pad plus shipping by UPS
ITEM# Format3 (Optometrist Format) Script Size: 4" x 5-1/2" Imprint maximum 4 Names or 3 Names plus Facility Name. Each name must be imprinted with License # and NPI # click to enlarge To Order ... click on the "Add to Your SHOPPING CART" button.	PC43-NJ (Optometrist Format) ONE PART SCRIPTS 100 sheets per pad
	20 pads ~ $7.55 per pad plus shipping by UPS 40 pads ~ $5.75 per pad plus shipping by UPS 80 pads ~ $5.05 per pad plus shipping by UPS 160 pads ~ $4.85 per pad plus shipping by UPS
ITEM# Format4 (Nurse Practitioner) Script Size: 4" x 5-1/2" click to enlarge If you are ordering Format 4 (Nurse Practitioner) New Jersey law requires only ONE Nurse Practitioner's name per script with ONE Collaborative Physician's name. Both the Nurse Practitioner's name and information plus the Collaborative Physician's name and information must be pre-printed on script. To Order ... click on the "Add to Your SHOPPING CART" button.	PC44-NJ (Nurse Practitioner) ONE PART SCRIPTS 100 sheets per pad
	20 pads ~ $7.55 per pad plus shipping by UPS 40 pads ~ $5.75 per pad plus shipping by UPS 80 pads ~ $5.05 per pad plus shipping by UPS 160 pads ~ $4.85 per pad plus shipping by UPS
ITEM# Format 5 (Physician Assistant) Script Size: 4" x 5-1/2" click to enlarge If you are ordering Format 5 (Physician Assistant) New Jersey law requires only ONE Physician Assistant's name per script with ONE Collaborative Physician's name. Both the Physician Assistant's name and information plus the Collaborative Physician's name and information must be pre-printed on script. To Order ... click on the "Add to Your SHOPPING CART" button.	PC48-NJ (Physician Assistant) ONE PART SCRIPTS 100 sheets per pad
	20 pads ~ $7.55 per pad plus shippingby UPS 40 pads ~ $5.75 per pad plus shipping by UPS 80 pads ~ $5.05 per pad plus shipping by UPS 160 pads ~ $4.85 per pad plus shipping by UPS

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Thank You for your order for Secure New Jersey Prescription Forms.
We appreciate your business.
Your order will ship in approximately 10 to 12 business days.
Please allow up to 4 days for shipping by UPS.