Supplies Ordering Form

Submitted by lisset on Fri, 01/02/2009 - 14:22

To order supplies, complete this form and click "Place Order". An AOD staff member will contact you to confirm your order. Or you may also call 954.724.9809.

Please note that the supplies on this order form are for use only on the Answers system.

Starter Kit Special:

On your first order, buy 1000 checks and receive 1000 FREE!
Buy 1000 statements and receive 1000 FREE!
That's over $100 of free supplies!

Please select the supplies you would like to order from the drop-down categories below:

Note: To place an order using quantity increments other than what is shown on this form, please list as "Special Instructions" in the area provided at the bottom of this form.

Check Supplies

L8870B-13 Blank Security Check - Blue (stub, stub, check) in thousands:

Part no. L8870B-13 Unit Price $65.60 per thousand

L8870BG-13 Blank Security Check - Burgundy (stub, stub, check) in thousands:

Part no. L8870BG-13 Unit Price $65.60 per thousand

L8870GN-13 Blank Security Check - Green (stub, stub, check) in thousands:

Part no. L8870GN-13 Unit Price $65.60 per thousand

MICR Toner Supplies

Select your Printer Type:

You may order more than one printer type by holding the Ctrl key while making your selections.

Quantity:

Please enter the quantity you would like to order for each of the Printer Types selected above.

MICR Cartridges Information for your Reference:

Item Code	Printer Type	Yield	Price (ea.)

MICR413	HP LaserJet 4	6000	$141.00
MICR4L13	HP 4L, 4P	3000	$112.00
MICR101213	HP 1010, 1012, 1015, 3015	4000	$156.00
MICR110013	HP 1100	2500	$121.00
MICR120013	HP 1200, 1220, 3300	3500	$146.00
MICR130013	HP 1300	4000	$169.00
MICR132013	HP 1320	6000	$243.00
MICR2015	HP 2015	7000	$441.00
MICR210013	HP 2100	6000	$177.00
MICR230013	HP 2300	6000	$230.00
MICR2400	HP 2400, 2420, 2430	12000	$263.00
MICR400013	HP 4000	6000	$187.00
MICR410013	HP 4100	10000	$208.00
MICR420013	HP 4200	12000	$260.00
MICR430013	HP 4300	18000	$303.00
MICR4350	HP 4350, 4250	20000	$362.00
MICR4500	HP 4500, 4550	9000	$167.00
MICR4V13	HP 4V	8100	$169.00
MICR500013	HP 5000, 5100	10000	$188.00
MICR5L13	HP 5L	2500	$114.00
MICR5P13	HP 5P	4000	$125.00
MICR5SI13	HP 5Si	15000	$330.00
MICR810013	HP 8100	21000	$269.00
MICR9000	HP 9000	30000	$418.00
MICRIPP13	HP IIP	3500	$120.00
MICRSI13	HP IISi/4Si	4000	$130.00
MICR3005	HP 3005 Low Yield	6500	$308.00
HP1160	HP 1160, 1320	2500	$256.20
MICR1505	HP 1505N		$236.00

PB & RB Blank Statement Forms

81548 Blank Statement Paper (1) Perforated, White in thousands:

Part no. 81548 Unit Price $36.00 per thousand

81549 Colored Blank Statement Paper (1) Perforated, Blue in thousands:

Part no. 81549 Unit Price $36.00 per thousand

81550 Colored Blank Statement Paper (1) Perforated, Green in thousands:

Part no. 81550 Unit Price $36.00 per thousand

81551 Colored Blank Statement Paper (1) Perforated, Burgundy in thousands:

Part no. 81551 Unit Price $36.00 per thousand

81552 Colored Blank Statement Paper (1) Perforated, Yellow in thousands:

Part no. 81552 Unit Price $36.00 per thousand

Envelopes

E44909-14 Blank Check & Blank Statement Envelopes in thousands:

Part no. E44909-14 Unit Price $58.52 per thousand

E44909S-14 Blank Check & Blank Statement Envelopes - Self Seal in thousands:

Part no. E44909S-14 Unit Price $90.00 per thousand

DWENV-05 W-2 Double Window Envelope in hundreds:

Part no. DWENV-05 Unit Price $21.60 per hundred

DWENVS W-2 Double Window Envelope - Self Seal in hundreds:

Part no. DWENVS Unit Price $30.00 per hundred

SWENV-05 W-2 Single Window Envelope in hundreds:

Part no. SWENV-05 Unit Price $21.60 per hundred

4UPDWENV-05 W-2 Double Window Envelope 4-Up in hundreds:

Part no. 4UPDWENV-05 Unit Price $26.40 per hundred

4UPDWENVS-05 W-2 Double Window Envelope 4-Up - Self Seal in hundreds:

Part no. 4UPDWENVS-05 Unit Price $56.00 per hundred

99DWENV-05 1099 Double Window Envelope in hundreds:

Part no. 99DWENV-05 Unit Price $15.20 per hundred

99SWENV-05 1099 Single Window Envelope in hundreds:

Part no. 99SWENV-05 Unit Price $15.20 per hundred

RDWENV-05 1099-R Double Window Envelope in hundreds:

Part no. RDWENV-05 Unit Price $21.60 per hundred

Tax Forms (laser)

4UPPERF-05 W-2 Blank Laser Perforated Paper, 4-Up in hundreds:

Part no. 4UPPERF-05 Unit Price $12.20 per hundred Compatible Envelope: 4UPDWENV-05

4UPPERFI05 W-2 Blank Laser Perforated Paper, 4-Up (with instructions on the back of form) in hundreds:

Part no. 4UPPERFI05 Unit Price $12.20 per hundred Compatible Envelope: 4UPDWENV-05

W24UPS6-05 W-2 Version 1, pre-printed, 4-Up in hundreds:

Part no. W24UPS6-05 Unit Price $42.40 per hundred Compatible Envelope: 4UPDWENV-05 * Not a recommended form

BINTFED-05 1099-Int Copy A Federal ONLY in hundreds:

Part no. BINTFED-05 Unit Price $9.04 per hundred Compatible Envelope: N/A

INTS305 1099-Int (3 part) pre-printed in hundreds:

Part no. INTS305 Unit Price $22.00 per hundred Compatible Envelope: 99DWENV-05 or 99SWENV-05

BRFED-05 1099-R Copy A Federal ONLY in hundreds:

Part no. BRFED-05 Unit Price $9.04 per hundred Compatible Envelope: N/A

RS405 1099-R (4 part) pre-printed in hundreds:

Part no. RS405 Unit Price $50.00 per hundred Compatible Envelope: RDWENV-05

BMISFED-05 1099-MISC Copy A Federal ONLY in hundreds:

Part no. BMISFED-05 Unit Price $9.04 per hundred Compatible Envelope: N/A

MISCS305 1099-MISC (3 part) pre-printed in hundreds:

Part no. MISCS305 Unit Price $30.00 per hundred Compatible Envelope: RDWENV-05

MISCS405 1099-MISC (4 part) pre-printed in hundreds:

Part no. MISCS405 Unit Price $40.00 per hundred Compatible Envelope: RDWENV-05

Contract-Health Care Forms

UB04 Hospital Claim Form:

Part no. UB04 Price for 1,000: $34.46 Price for 2,500: $55.00 Price for 5,000: $111.54 Price for 10,000: $215.93

HCFA 1500 Forms:

Part no. 1500NC Price for 1,000: $32.30 Price for 2,500: $57.75 Price for 5,000: $111.00 Price for 10,000: $197.00

Bill to:

Your Name: *

Facility: *

Email Address: *

Phone Number: *

Ship to:

Name: *

Facility Name: *

Address 1: *

Address 2:

City: *

State: *

Zip Code: *

Special Instructions:

Please list any incremental quantities other than the options available above. Also, please add any comments, notes or special instructions.

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