Left Running Ticket
CMS Prescription Pads
Size 4 ¼” x 5 ½”

KWIKTICKETS.COM Inc.

Toll Free: 1-877-515-5219 or Fax: 724-438-6050
Email: orders@kwiktickets.com

Your on-line source for numbered Tickets and more!
Right Running Ticket

Large Quantities, KWIK!
300,000 to 1 Million TICKETS - FAST

SECURE PADS
USA and Canada
Proud to be an American Company!

Email Us / Main Menu

Toll Free 1-877-515-5219
All information given on this page is encrypted and on a Secured Server for your privacy.

Ready For October 2008 Requirements 
Each of our security prescription paper items meets - and exceeds - the October 2008 requirements set by the
Centers for Medicaid and Medicare Services (CMS). Remember that by October 1st,  to be considered tamper-resistant,
a security paper item must contain at least three security features.  

  

Security features on the Prescriptions are:
  • Tamper resistant background ink shows attempts to alter scripts.
  • Penetrating ink is used to prevent chemical "lifting" of information.
  • High security watermark on backside, which can not be copied.
  • Hidden security "VOID" appears when photocopied.
  • Each sheet is sequentially numbered for record keeping.
  • Copy resistant security pantograph discourages duplication.
  • Micro-Lock Logo and security screen with INK THAT RESPONDS TO WARMTH. Hold between thumb and forefinger or breathe on it - THE LOCK LOGO WILL FADE AND DISAPPEAR.
WARNING: ABSENCE OF THE FOLLOWING SECURITY FEATURES
MAY INDICATE ALTERATION.
We also offer tear apart 8 1/2 x 11 laser sheets and 2 part sheets 8 1/2 x 11.
Please call for samples and pricing.

To order by FAX or Mail
Download this order form
Prescription Pad Order Form
and fax your order to 724 - 438 - 6050.

Or fill out the information below for secured online ordering.

Your Prescription Pad Information
( Match Your Info With Numbered Locations )

Logo :


Add Logo ( $ 15.00 charge to add logo )

Line 1:

Line 2:

Line 3:

Line 4:


Additional Ticket Options


Choose Quantity & Price For:
 

1 Part Security Pad (4up1P)

Each pad contains 100 sheets

  2 Part Security Pad (4up2P)

Each pad contains 100 sheets
Second Copy is unprinted yellow sheet with no security features.


 

10 Pads = 1,000 Scripts
25 Pads = 2,500 Scripts
50 Pads = 5,000 Scripts
100 Pads = 10,000 Scripts

 
10 Pads = 500 Scripts
25 Pads = 1,250 Scripts
50 Pads = 2,500 Scripts
100 Pads = 5,000 Scripts
 
Color:

General Ticket Information
  • Standard production time is 7 to 10 days.
  • Rush Service Available.
  • Shipping Options: Please contact us for Express and other shipping options.
  • Limit 8 Prescribers per pad.

    Questions?
    Need something different? Prefer to talk to a real person?
    Call us Toll Free
    1-877-515-5219, Fax: 1-724-438-6050
    Office Hours 8:00 a.m. - 5:00 p.m. EST

  • NEED TICKETS IN A HURRY?
    CHOOSE AN EXPEDIATED SERVICE
    FOR AN EXTRA CHARGE!

    RUSH Service $45.00
    (Proof in 1 day. Ships 3 days from approval)

    Large orders do not qualify.

    EXPRESS Service $85.00
    (Proof ready same day. Ships 2 days from approval.
    Approval must be received by 2:00 pm EST)
    Large orders do not qualify.
    METHOD OF SHIPPING
    Ground (5 days or less to most US locations)
    Second day Air

    Next day Air


    Your Order Information
    ( * Designates Required Fields )

    *Your Name:

    Company/Org. :

    *Shipping Address:

    *Shipping is? :

    Residential Business
    *CityStateZip:
    *Phone:
    Fax: Used for your proofs
    *E-mail:

    *Credit Card:

    Card Address:


    Address
    City, State, Zip

    *Name On Card:

    *Card Number:

    *Expiration Date:

    |

    *CVV/CID (security code):

    *Special Instructions or Comments:

    Please review your order!

    How can we send your proof?

    Email Fax
    Security Image Verification
    Type the characters below, exactly as shown into the box provided.
    Captcha Security Code: Enter Security Code Below:  
     

    If you do not receive an order confirmation or proof within 24 Hours,
    please contact our office:

    Toll Free 877-515-5219 / Email us


    Questions?
    Need something different? Prefer to talk to a real person?
    Call us Toll Free
    1-877-515-5219, Fax: 1-724-438-6050
    Office Hours 8:00 a.m. - 5:00 p.m. EST
    KwikTickets.com Inc. Logo