Medical Prescription Scripts
for use in the State of New Jersey
For NEW JERSEY prescription forms
Micro Format is a distributor for PRINTCO, INC.
PRINTCO is a New Jersey approved manufacturer for Prescription Pads and Laser Scripts.
The state of New Jersey has made changes to their prescription form program.
The changes will improve the security of all New Jersey Rx forms by adding security features to reduce fraud.
Click for additional details.
PLACE YOUR ORDER TODAY.
~This is a SECURE Order Form ~
PRINTCO Imprinted Prescription Pads
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.
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 on behalf of Printco, Inc., 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 It is for your protection.
Your order WILL NOT BE PROCESSED until your License has been received.
We appreciate your co-operation with this requirement.
New Jersey State Law requires that Micro Format, on behalf of Printco, Inc., maintains on file the signature for each prescriber that appears on the script.
If more than on prescriber appears, the RESPONSIBLE PRESCRIBER must be indicated.
to obtain the required signature document.
Please complete this document and send it by FAX to Micro Format, Inc.
ONE PART SCRIPT:
Distinctive GREEN New Jersey background
with required security features
100 sheets per pad
Click to Order 1 part scripts
TWO PART SCRIPT:
Part 1 has Distinctive GREEN New Jersey background with required security features
Part 2 is a BLANK YELLOW sheet
50 sets per pad with wrap-a-round cover
Click to Order 2 part scripts
QUESTIONS: Please send us an e-mail firstname.lastname@example.org
Copyright © 2004- Micro Format, Inc., All Rights Reserved
Micro Format, Inc.
830-3 Seton Court ~ Wheeling, IL 60090
Phone: 847/520-4699 ~ 800-333-0549