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Page Size 8-1/2 x 11
Page Size 11 x 17
Thermal Continuous Forms
New Jersey Eyeware Pad
This prescription pad is 4 x 5-1/2 inches.
The format will fit five (5) lines of text, including the Practice Name, up to Three Providers and One Address, or Four Providers and no Practice Name.
This format is available as either a One-Part Script or a Two-Part Script: One-Part Pads have the secure prescription and contain 100 sheets per pad. Two-Part Pads have the secure prescription and a blank yellow carbonless copy. They contain 50 sets per pad and include a protective wrap-around cover.
Back Printing available for an additional charge if additional addresses are desired.
Each Providers License and NPI must be pre-printed on the prescription. Please include this information in the imprint section, when placing order.
All prescriptions in New Jersey must be consecutively number, please select YES in the CONSECUTIVE NUMBERING box when asked.
20 Pads per Pack
$220.00 - $345.00