New Jersey approved Prescription Script Pads

www.NewJerseyRxPaper.com
www.NewJerseyPrescriptionPaper.com

Custom Imprinted
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.

NEW JERSEY SCRIPT REGULATIONS UPDATE

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.

Order Form
~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. =

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 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
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.

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.
Please visit
www.newjerseyrxpaper.com/FileSignature.pdf
to obtain the required signature document.
Please complete this document and send it by FAX to Micro Format, Inc.
FAX# 847-520-0197

Available Formats
MD, DO, DS, DMD, DPM, DVM click to enlarge	Physician Assistant click to enlarge	Nurse Practitioner click to enlarge	Facility Format click to enlarge	Midwife click to enlarge	Optometrist Format click to enlarge	EyeWare click to enlarge

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 support@rxpaper.com

rev 06/2014