Answers On Demand - Your solution to Managed Healthcare Software
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Corporate:
8100 North University Drive
Third Floor
Fort Lauderdale, Florida 33321
Regional:
1650 Tri Park Way
Suite C
Appleton, WI 54914
Phone: 954.724.9809
Fax:      954.720.5978
Phone: 920.996.2380
NOTE: All fields with "*" are required entries.
* Name:
* Company:
* Phone:
* E-mail:
Subject:
Note: To place an order using quantity increments other than what is shown on this form, please list as "Special Instructions" in the Comments field at the bottom of this form.
Select item(s)
Product Description
Indicate Quantity Desired
L8870B-13 Blank Security Check, Blue (stub, stub, check)
Thousand
L8870BG-13 Blank Security Check, Burgundy (stub, stub, check)
Thousand
L8870GN-13 Blank Security Check, Green (stub, stub, check)
Thousand
MICR Toner
                
MICR Toner
                 
81548 Blank Statement Paper (1) Perf, White
Thousand
81549 Colored Blank Statement Paper (1) Perf, Blue
Thousand
81550 Colored Blank Statement Paper (1) Perf, Green
Thousand
81551 Colored Blank Statement Paper (1) Perf, Burgundy
Thousand
81552 Colored Blank Statement Paper (1) Perf, Yellow
Thousand
E44909-14 Blank Check & Blank Statement Envelopes
Thousand
E44909S14 Blank Check & Blank Statement Envelopes - Self Seal
Thousand
DWENV-05 W-2 Double Window Envelope
Hundred   
DWENVS W-2 Double Window Envelope - Self Seal
Hundred   
SWENV-05 W-2 Single Window Envelope
Hundred   
4UPDWENV-05 W-2 4-Up Double Window Envelope
Hundred   
4UPDWENVS-05 W-2 4-Up Double Window Envelope - Self Seal
Hundred   
99DWENV-05 1099 Double Window Envelope
Hundred   
99SWENV-05 1099 Single Window Envelope
Hundred   
RDWENV-05 1099-R Double Window Envelope
Hundred   
4UPPERF-05 W-2 4-Up Blank Laser Perforated Paper
Hundred   
4UPPERFI05 W-2 4-Up Blank Laser Perforated Paper
with instructions on back of form.
Hundred   
W24UPS6-05 W-2 4-Up Version 1 (laser) pre-printed
Hundred   
BINTFED-05 1099-Int (laser) Copy A Federal ONLY
Hundred   
INTS305 1099 INT (3 part) pre-printed
Hundred   
BRFED-05 1099-R (laser) Copy A Federal ONLY
Hundred   
RS405 1099 R (4 part) pre-printed
Hundred   
BMISFED-05 1099-MISC (laser) Copy A Federal ONLY
Hundred   
MISCS305 1099 MISC (3 part) pre-printed
Hundred   
MISCS405 1099 MISC (4 part) pre-printed
Hundred   
UB04 Hospital Claim Form
Thousand   
Notes, comments, or special instructions. Please list incremental quantities other than what is listed above here: