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ADA Claim Form Pads

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    •  
    • 1990 vers.
    • 2000 vers.
    • 1995 vers.
    • 2002 vers.
    • 5
    • $71.00 $14.20 each
    • $52.00 $10.40 each
    • $59.00 $11.80 each
    • $45.00 $9.00 each
    • 10
    • $114.00 $11.40 each
    • $83.00 $8.30 each
    • $96.00 $9.60 each
    • $73.00 $7.30 each
    • 15
    • $160.00 $10.67 each
    • ---
    • $134.00 $8.93 each
    • ---
    • 20
    • $197.00 $9.85 each
    • $147.00 $7.35 each
    • $165.00 $8.25 each
    • $128.00 $6.40 each
    • 25
    • $242.00 $9.68 each
    • $232.00 $9.28 each
    • $202.00 $8.08 each
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    • 50
    • $469.00 $9.38 each
    • $350.00 $7.00 each
    • $393.00 $7.86 each
    • $306.00 $6.12 each
    • 100
    • $916.00 $9.16 each
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    • $767.00 $7.67 each
    • ---
    • 150
    • $1,334.00 $8.89 each
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    • 200
    • $1,729.00 $8.65 each
    • $1,662.00 $8.31 each
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    • 250
    • $2,102.00 $8.41 each
    • $2,021.00 $8.08 each
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    • 500
    • ---
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    • ---
    • $26.00 $0.05 each

Product Specifications

  • Ref.: 4045
  • Size: 8 1/2" x 11"
  • 100 forms per pad
  • Minimum quantity is 5 pads of 100 = 500 forms
  • Available in 1990, 1995, 2000 or 2002 version
  • Choice of typestyles for your practice name
  • SSN or TIN (1 line)
  • License & Phone Number
  • Practice name & Address (3 lines)
  • Min. Order: 5 pads

Product Description

Speed third-party billing! These ADA claim forms come imprinted with your parctice name and address (up to 3 lines), your SSN or T.I.N., license number and phone.

Turnaround Time

No logo:

3 Business Days + Shipping

With logo or extra lines of print:

7 Business Days + Shipping

Turnaround times above are only estimates. Orders with corrupt artwork, missing fonts, low resolution logos, too much text in the personalization, etc. will be delayed until that issue is resolved.

The processing of your order will only start once the issue has been resolved. Finally, although very rare, issues such as a broken plates can occur and may also delay your order, so please try to plan a printing job well in advance of your deadline.

Orders placed after 2pm will be processed the next business day.

Shipping Destinations

Destinations:

U.S.A. and Canada

Shipping Methods:

UPS (Ground, Second Day Air or Next Day Air)

Shipping charges are calculated based on the final amount of your order, please see our Shipping Chart to find out more.

Our Guarantee 100% Guarantee
See Also
Laser ADA Claim Forms
Product# 4542 Laser ADA Claim Forms