Order Supplies Please fill out the form below, and check your option(s). Fields marked with an asterisk(*) are required. Please fill out the form below, and check your option(s). Fields marked with an asterisk(*) are required. Practice Manager Supplies NOTE: Below prices include Standard UPS Shipping. We cannot guarantee that forms purchased from other suppliers will be compatible with ChartMaker Practice Manager. ** DUE TO RISING SHIPPING AND RESTOCKING FEES, WE ARE NO LONGER ABLE TO ACCEPT RETURNS, NO EXCEPTIONS. PLEASE DOUBLE CHECK ALL FIELDS PRIOR TO SUBMITTING.**(CM44) CMS 1500 Form (ICD-10)Quantity Per Box : 2500 Price per box = $90; $85 each for 3+ boxes Printer type: Laser Envelope, Self-Sealing w/ (Address Correction Requested Imprinted - 2-window)Quantity Per Box : 1000 Price per box = $108 Envelope, Large Insurance (Used for CMS 1500) forms)Quantity Per Box : 100 Price per box = $50; $48 each for 3+ boxesUB-04 FormsQuantity Per Box : 2500 Price per box = $80; $75 each for 3+ boxes Printer type: Laser PATIENT STATEMENT (CUT - SHEET - for LASER PRINTER ONLY)Quantity Per Box : 2000 Price per box = $154; $145 each for 3+ boxes Printer type: Laser Please be advised that the return of patient statements, either partial or full boxes will not be accepted. It is our hope that you will find our Electronic Patient Statements and Provider Complete services to be a better option for your office. Ask us about it today to get started or learn more HERE. Computer Supplies Price List Hewlett Packard 1320 Toner Cartridge (Q5949A)Quantity Per Box : 1 Price per box = $129; $125 each for 3+ boxesHewlett Packard P1505 Toner (CB436A)Quantity Per Box : 1 Price per box = $100; $97 each for 3+ boxesHewlett Packard P2015N TONER (53A)Quantity Per Box : 1 Price per box = $129; $125 each for 3+ boxesHP P3015 TONER (CE255A)Quantity Per Box : 1 Price per box = $189; $185 each for 3+ boxesHP 1606 TONER (CE278A)Quantity Per Box : 1 Price per box = $105; $101 each for 3+ boxesHP LaserJet M401n Toner Cartridge (CF280A)Quantity Per Box : 1 Price per box = $130; $126 each for 3+ boxesHP LaserJet M401n Toner Cartridge- HIGH YIELD (CF280X)Quantity Per Box : 1 Price per box = $225; $221 each for 3+ boxesHP LaserJet M402n Toner Cartridge (CF226A)Quantity Per Box : 1 Price per box = $149; $145 each for 3+ boxesHP LaserJet M402n Toner Cartridge (CF226X) High YieldQuantity Per Box : 1 Price per box = $249; $245 each for 3+ boxesHP LaserJet M404n Toner Cartridge (CF258X) High Yield (10k pages)Quantity Per Box : 1 Price per box = $259; $255 each for 3+ boxesHP LaserJetM404n Toner Cartridge (CF258A) (3k pages)Quantity Per Box : 1 Price per box = $129; $125 each for 3+ boxes---------------------------------------------------------------------------------------------------------------------------------------------------------------- Please fill out the form below. Fields marked with an asterisk(*) are required.Practice Name*Client ID*Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Enter Email Confirm Email Best time to call:Additional Comments (optional):CAPTCHA