When Requested,
Please accurately fill-in the information that needs to be imprinted on the top of each sheet.

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 $25.00 per 1000.
  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 2009 (immediately),
  New Jersey Law requires that all Rx Scripts be consecutively numbered

New Jersey Laser Prescription Forms Format #1 (MD,DO,DS,DMD,DPM,DVM) Imprint up to 3 Names or 2 Names plus Facility Name Each name must be imprinted with License # and NPI # New Jersey Law requires that all Prescription Paper MUST be consecutively numbered. This has added an additional $25.00 per 1000 to the cost of New Jersey Script Paper.

ENLARGE VIEW Item# NJMD1 8-1/2" x 11" One Script-Top Left Script Size 4" x 5-1/2" To order ........ Click On "Add to Shopping Cart" 2,500 sheets $432.50 plus shipping by UPS 5,000 sheets $650.00 plus shipping by UPS 10,000 sheets $1,070.00 plus shipping by UPS