California Prescription Paper Imprinting Information
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 California Regulations, un-imprinted laser scripts are not available.

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

• California law requires scripts must contain both the DEA# and License# for each doctor listed.
  

• Under California Law ... ALL California Laser Prescription Paper
  MUST BE SHIPPED to the address on file with the DEA

• Printing additional names and/or locations on the back of the script is
  available at an additional charge of $34.00 per 1000.
  This charge will be added to the total price of your order.
  For additional information please CALL Customer Service at (800)333-0549.

After you complete your order ...
The California Department of Justice requires that a copy of your DEA Registration be sent to us by FAX.
This is a State requirement.
We cannot process any order for which we do not have a current DEA Registration form on file.
Please FAX a copy of your DEA Registration form to
MICRO FORMAT Customer Service
Fax Number: (847)520-0197
Thank you.

Once we receive your DEA Registration Certificate, it will be reviewed along with your order form. After it has been determined that everything is in order, your order will be processed.

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Micro Format Secure Laser Prescription Paper contains all of
the features required by the California State Pharmacy Board.

Two Formats available:
1) Sheet Size: 5-1/2" x 8-1/2" ~ Detached Prescription Size: 5-1/2" x 4-1/4"
2) Sheets Size 801/2" x 11" ~ Detached Prescription Size: 5-1/2" x 4-1/4"

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California Approved Laser Prescription Paper
Item #RxL775 Sheet Size: 8-1/2" x 11"	Item #RxL785 Sheet Size: 5-1/2" x 8-1/2"
Item# RxL775 Script Size: 5-1/2" x 4-1/4" Imprint up to 4 Names (3 Names plus Facility) To order ........ Click On "Add to Shopping Cart" 1,000 sheets ~ $199.00 plus shipping by UPS 2,000 sheets ~ $312.00 plus shipping by UPS 4,000 sheets ~ $539.00 plus shipping by UPS 8,000 sheets ~ $988.00 plus shipping by UPS	Item# RxL785 Script Size: 5-1/2" x 4-1/4" Imprint up to 4 names (3 Names plus Facility) To order ........ Click On "Add to Shopping Cart" 2,000 sheets ~ $320.00 plus shipping by UPS 4,000 sheets ~ $475.00 plus shipping by UPS 6,000 sheets ~ $659.00 plus shipping by UPS 8,000 sheets ~ $839.00 plus shipping by UPS

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QUESTIONS: Please send us an e-mail

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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
Fax 847/520-0197

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rev 07/2013