Laser Security Paper

Your Contact Information

Name*

First Last

Phone*

Email*

Your Shipping Address*

Street Address Address Line 2 City State ZIP Code

Intended Usage

Select State for Prescription Compliance*

What would you like printed on the security paper?*

Security Paper Color*

Blue
Green

Security Paper Type*

Maximum Security
Minimum Security

Maximum Security stock is blue, and boasts 11 included security features, while Minimum Security is green and has 7. Both options meet your state's requirements.

Starting Number

If left blank, your numbering will start at 0001.

Printed Location Information

Clinic or Business Name

Number of Office Addresses to Include*

Address #1*

Street Address Address Line 2 City State ZIP Code

Phone*

Fax

Address #2*

Street Address Address Line 2 City State ZIP Code

Phone*

Fax

Address #3*

Street Address Address Line 2 City State ZIP Code

Phone*

Fax

Prescriber(s)

Select Number of Prescribers*

Hide DEA Numbers?*

Yes
No

We still require this information for verification purposes.

Prescriber #1*

First Middle Last Designation

License Number*

DEA Number*

NPI Number (optional)

Prescriber #2*

First Middle Last Designation

License Number*

DEA Number*

NPI Number (optional)

Prescriber #3*

First Middle Last Designation

License Number*

DEA Number*

NPI Number (optional)

Prescriber #4*

First Middle Last Designation

License Number*

DEA Number*

NPI Number (optional)

Prescriber #5*

First Middle Last Designation

License Number*

DEA Number*

NPI Number (optional)

Prescriber #6*

First Middle Last Designation

License Number*

DEA Number*

NPI Number

10 digits (optional)

Quantity of Blank Laser Sheets*

Quantity of Minimum Security Laser Sheets*

Quantity of Maximum Security Laser Sheets*

Quantity of Blank Delaware Laser Sheets*

Prescriptions are created two-up on each sheet, with a perforation down the center for easy tearing and separation after printing.

Quantity of California Laser Sheets*

Production Time*

Standard
Rush

Standard is 7 business days, while rush is 3 business days.
Shipping time not included, additional fees apply for rush.

Production Time*

Standard
Rush

Standard is 5 business days, while rush is next business day.
Shipping time not included, additional fees apply for rush.

How did you hear about us?

Search Engine
State or Federal Agency List
Referral

Notes or Customization Requests

Please note:

For enhanced security, we review your submission for accuracy and compliance, and will generate a secure digital proof for printed selections, free of charge.

This will be send via email, along with a digital invoice, within one business day of receiving your order.

Rush processing requests will be reviewed and processed immediately.

Phone

This field is for validation purposes and should be left unchanged.

Current with state and federal guidelines and regulations

Guaranteed to be compliant and accepted by all pharmacies.

Begin Your Secure Laser Rx Paper Order

Your Contact Information

Intended Usage

Printed Location Information

Prescriber(s)

Please note: