Prescription Script Pad Order

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.

Please Read ~ Additional New Jersey Requirements

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) Use this format when ordering the Midwife Format; In comment section of order form note "Midwife" click to enlarge	Format 5 (Physician Assistant) click to enlarge

ONE PART SCRIPT: Distinctive BLUE New Jersey background 100 sheets per pad Click to Order 1 part scripts
TWO PART SCRIPT: Part 1 has Distinctive BLUE New Jersey background Part 2 is a BLANK YELLOW sheet 50 sets per pad with wrap-a-round cover Click to Order 2 part scripts