REORDER PRESCRIPTION PADS: CLICK HERE
1-part New Jersey Prescription Pads
Welcome to our online ordering system; the online ordering system is for one part (1-part) New Jersey prescription pads only.
In New Jersey, to order prescription pads online, two preliminary steps are necessary, as follows:
Step 1:
New Jersey requires the Signature form below be provided and completed before we can process the order.
Click here to download a writable PDF form.Once the form is completed and the Doctors sign (the State requires live signatures), scan and email to: .
Step 2:
Click here to get your online proof for the practice.
The proof will be a little blurry. This is done intentionally for security purposes.
Then place your order.
We will need both the forms before we can process an order.
The freight cost will be added once you submit the order
For quantities over 100 pads, please call 908-392-4664.
Pricing for 1-part pads, no address backer
| Pads | 10 | 20 | 40 | 100 |
| 100 scripts per pad | $100.00 | $138.00 | $230.00 | $469.00 |
Pricing for 1-part with address backer
| Pads | 10 | 20 | 40 | 100 |
| 100 scripts per pad | $140.00 | $210.00 | $332.00 | $715.00 |
Freight is as follows:
- 10 pads $17.00
- 20 pads $19.00
- 40 pads $ 34.00
- 100 pads $56.00
Freight cost will be added directly to the order.
Two-part and laser online ordering will be coming shortly
Two-part or laser prescription forms in New Jersey
If you are looking for two-part or laser prescription forms, New Jersey requires the following form before we can process the order:
Once it is filled out and the Doctors sign (State requires live signatures), scan and send to
A proof will be sent to you via email.
Click here for writeable PDF form.
No handwritten forms will be accepted
For any orders over 100 Pads or 3000 laser sheets call 908-392-4664.
Pricing for 2-part with no address backer
| Pads | 10 | 20 | 40 | 100 |
| 50 scripts per pad | $138.00 | $214.00 | $269.00 | $585.00 |
Pricing for 2-part with address backer
| Pads | 10 | 20 | 40 | 100 |
| 50 scripts per pad | $198.00 | $247.00 | $356.00 | $835.00 |
Freight is as follows:
- 10 pads $17.00
- 20 pads $19.00
- 40 pads $ 34.00
- 100 pads $56.00
Freight cost will be added directly to the order
Laser Sheets no address backer
| Quantity | 500 | 1000 | 2000 | 3000 |
| Price | $165.00 | $220.00 | $358.00 | $434.00 |
Laser Sheets with address backer
| Quantity | 500 | 1000 | 2000 | 3000 |
| Price | $220.00 | $310.00 | $560.00 | $825.00 |
Freight is as follows:
- 500 Sheets $16.00
- 1000 Sheets $19.00
- 2000 Sheets $ 39.00
- 3000 Sheets $56.00
Freight cost will be added directly to the order.