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CMS-1500 Insurance Claim Forms - New for 2007 CMS-1450 Insurance Claim Forms (Not Illustrated) - New for 2007 Meet New Requirements for April & May 2007 Size: 8-1/2" x 11"

CMS-1500 1 Part Laser Forms

CMS-1500 - With Your Company Imprint (Our #MCF-387-1) Quantity 250 500 1000 2000 Price 34.90 44.10 53.70 97.60 Shipping* 13.37 13.37 19.10 22.92 Total 48.27 57.47 72.80 120.52 Quantity: 250 500 1000 2000 Imprint color: BlackRedBlueGreen NOTE: Imprint color is for your company imprint only - form is color shown on screen. You will be asked for imprint information during checkout process.

CMS-1500 - No Company Imprint (Our #MCF-387-1) Quantity 250 500 1000 2000 Price 17.45 22.05 26.85 48.80 Shipping* 13.37 13.37 19.10 22.92 Total 30.82 35.42 45.95 71.72 Quantity: 250 500 1000 2000

CMS-1500 2 Part Carbonless Sets

CMS-1500 - With Your Company Imprint (Our ##MCF-387-2) Quantity 250 500 1000 2000 2500 Price 56.60 75.00 92.60 176.40 219.50 Shipping* 13.37 17.19 21.01 30.56 36.29 Total 69.97 92.19 113.61 206.96 255.79 Quantity: 250 500 1000 2000 2500 Imprint color: BlackRedBlueGreen NOTE: Imprint color is for your company imprint only - form is color shown on screen. You will be asked for imprint information during checkout process.

CMS-1500 - No Company Imprint (Our #HAC-681-3-BL) Quantity 250 500 1000 2000 2500 Price 39.62 52.50 64.82 123.48 153.65 Shipping* 13.37 17.19 21.01 30.56 36.29 Total 52.99 69.69 85.83 154.04 189.94 Quantity: 250 500 1000 2000 2500

CMS-1450 (UB-04) Claim Forms (Not Illustrated) -

CMS-1450 Laser Forms No Company Imprint (Our #MCF-389-1) Quantity 250 500 1000 2000 Price 34.90 44.10 53.70 97.60 Shipping* 13.37 13.37 19.10 22.92 Total 48.27 57.47 72.80 120.52 Quantity: 250 500 1000 2000

CMS-1450 2 Part Sets No Your Company Imprint (Our #MCF-389-2) Quantity 250 500 1000 2000 2500 Price 56.60 75.00 92.60 176.40 219.50 Shipping* 13.37 17.19 21.01 30.56 36.29 Total 69.97 92.19 113.61 206.96 255.79 Quantity: 250 500 1000 2000 2500

Shorty's Place in Cyberspace
800-746-7897 or 904-636-0824   Fax: 904-448-2001
Contact Us: Samples, Quotes, Questions or Comments

* Shipping charges are for ground shipment to the 48 contiguous states. For shipping charges to other locations, or for faster shipment email us or call Shorty's Place in Cyberspace at 800-746-7897 or 904-636-0824

** Production is time from when order is entered to when it is shipped. It does not include shipping time. If you desire a proof, production time begins when the proof is approved. Production time is in working days, weekends and holidays are not counted.

For quantities larger than shown, or if you don't see the form you want, email us or call Shorty's Place in Cyberspace at 800-746-7897 or 904-636-0824