Reorders (use this form) go-to REORDER PRESCRIPTION PADS
FIRST TIME USERS
- GO TO ONLINE PORTAL AND REGISTER
- PICK OUT THE CORRECT PRESCRIPTION PAD
- FILL OUT THE ONLINE FORM
- VIEW THE PROOF
- CHECK OUT
- NEW CUSTOMERS FILL OUT THE NEW JERSEY STATE SIGNATURE FORM
(ORDER WILL NOT BE PROCESSED WITHOUT THE NEW JERSEY STATE SIGNATURE FORM AS REQUIRED BY STATE LAW)
Scan completed form and send to .
We recommend that all Doctors, APN, P.A. etc., fill out for future use.
So, you have to do one time only.
New Customers
ALL PRESCRIPTION PAD ORDERS WILL SHIP DIRECTLY TO THE ADDRESS ON FILE WITH THE STATE OF NEW JERSEY. IF YOU WISH TO SHIP TO ANOTHER LOCATION YOU MUST CHANGE YOUR ADDRESS WITH THE STATE OF NEW JERSEY AND SEND US THE APPROVAL FORM FROM THE STATE OF NEW JERSEY.
- If the online form does not meet your needs go to Custom Forms below.
FOR CUSTOM PRESCRIPTION FORMS
- Go to the Ordering Customized One-part, Two-part or Laser Prescription Pads form
- Fill out form
- This a writable PDF and no handwritten forms will be accepted
- Print and Sign
- Scan and email to
- If you have a copy of your last script, please send with form
If you are still having problems, with ONLINE OR CUSTOM ordering you can reach me at 908-392-4664 any time and will gladly take care of any issues you are having.
Pricing
For any orders over 100 Pads or 3000 laser sheets call 908-392-4664 for pricing.
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.
Pricing for Customized one-part pads:
will be discussed and finalized before printing.
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.