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Item #MCF-389-1 Claim Form

CMS-1450 revised 1-part insurance claims form for laser printer. National Uniform Claim Committee approved version. Accommodates the National Provider Identifier (NPI) number. Priced per each. Blank only. Sized envelope available, please inquire.

1
$0.04
 

Most samples are printed with a past client's logo to show imprint quality. Samples are intended for those considering placing a bulk order and therefore a $20 shipping and handling fee will apply (maybe refunded if bulk order is placed). $0.04 price is valid for single item sample orders only. See bulk/custom pricing to order more than 1 of these items.

Colors
White
Size
8 1/2 " x 11 "
Material
Paper
Additional Information
Your satisfaction is guaranteed. We are proud of the work we do. If we don't do it right, we'll make it right. Period.

Product Detail

  • Booking available. Carbonless Snap-A-Part Forms can be booked into sets of 50 (stapled through the stub and wrapped with a heavy manila backer).

    • Charge Type: Product Option Charge (Per Quantity)

      Quantity1
      Price$12.73

      Price Includes: N/A

    • Carbonless Snap-A-Part Forms

  • Envelopes

    • Charge Type: Product Option Charge (Per Quantity)

      Quantity1
      PriceQuoted

      Price Includes: N/A

    • Envelopes available

  • Product Option

    Hole Punches are available
    • 1 hole
    • 2 holes
    • 3 holes
    • 4 holes

  • Product Option

    Multi-Part Color Sequence available
    • Multi-Part Color Sequence

  • Product Option

    Stock logos available
    • American flag - MI-3
    • Capsule "RX" - DR-1
    • Mortar & Pestle - DR-2
    • Mortar & Pestle "RX" - DR-4
    • Mortar & Pestle Bold "RX" - DR-3
    • Quote "Thank You" - MI-1
    • Skull and bones - DR-6
    • Sun - MI-2
    • US "Small Business keeps America Growing" - MI-4

Imprint

Imprint Method: Unimprinted

Full Color Process: No

Personalization: No

Sold Unimprinted: Yes

Imprint Method

Unimprinted

Production and Shipping

  • Packaging

    • Packing with drilled holes - Per 500

      • Charge Type: Packaging Charge (Per Quantity)

        Quantity500
        Price$0.04

        Price Includes: N/A

    • Packing without drilled holes - Per 100

      • Charge Type: Packaging Charge (Per Quantity)

        Quantity50010005000
        Price$0.03$0.02$0.02

        Price Includes: N/A

    • Packing without drilled holes - Per 50

      • Charge Type: Packaging Charge (Per Quantity)

        Quantity2505001000
        Price$0.05$0.04$0.03

        Price Includes: N/A

  • Rush Time

    Rush Service

    Rush Service

    • Charge Type: Rush Service Charge (Other)

      Quantity1
      PriceQuoted

      Price Includes: N/A

 

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