Secure LASER Prescription Paper - New Jersey Format

NEW JERSEY LAW REQUIRES:

• The License Number and NPI# to be printed for each doctor.
  
• Only ONE LOCATION may appear on the front of the script.
• All doctor's names MUST be printed on the front of the script.
  The font "point size" can be no smaller than 7pt. Additional names MAY NOT be printed on the back of the script.
• ADDITIONAL LOCATIONS may be printed on the back of the script at an additional charge of $45.00 per 1000.
  
• New Jersey Law requires that all Rx Scripts be consecutively numbered

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.
This insures that we are following New Jersey State Law.
State Law requires us to ship to the address as shown on your NJ License.
We appreciate your co-operation with this requirement.

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New Jersey State Law requires that Micro Format maintains on file the signature for each prescriber that appears on the script.
If more than one 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

ENLARGE VIEW

LASER EyeWear-1
8-1/2" x 11"
One Script-Top Left
Script Size 4" x 5-1/2"

To order ........
Click On
"Add to Shopping Cart"

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2,500 sheets
$750.00 plus shipping
by UPS

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5,000 sheets
$1,000.00 plus shipping
by UPS

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10,000 sheets
$1,450.00 plus shipping
by UPS