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Home > MEDICAL / CHIROPRACTIC > Medical Forms > Encounter Forms / Superbills >

Custom Encounter Forms

Alternative Views:

ACS Custom Encounter/Superbills; 9-1/2" x 11" Continuous Pin-feed, Perforated out to 8-1/2" x 11", 3 - Parts. Customer to provide art work if available. If not send us your previous sample, sketch or typewritten draft and layout of what you want us to print we will do the rest. Make sure your codes are up-to-date and accurate.

9-1/2" x 11" Three Parts Pinfeed Includes

Custom Print Front
Forms are printed with your choice of codes, descriptions and formats.
Continuous
3 part White 16# CB, Canary 15# CFB & Pink 15# CF
9-1/2â€ x 11â€
Your Choose of One Ink Color - Black, Brown, Burgundy, Green, Orange, Process Blue, Red, Reflex Blue
After Approved Proof Ships in 7 Working Days
Quantities Over 10,000 Ship In 10 Working Days

Add-Ons for Additional Charges
Numbering $55.00
Second Color $90.00
Print Back Copy Black Ink $90.00
3 Day Rush Orders Ships in 3 Days After Approved Proof $175.00

Email all Art to [email protected]
Mail to: ACS PO Box 5088 Georgetown, Texas 78627

Choose Your Options Below and Then Click Update Price to See Your Total Price.

Product Code: ES9.5-3

Choose Your Quantity

500 [Add $360.00]
1,000 [Add $380.00]
2,500 [Add $787.50]$315.00 per 1,000
5,000 [Add $1,225.00]$245.00 per 1,000
10,000 [Add $1,950.00]$195.00 per 1,000
20,000 [Add $3,500.00]$175.00 per 1,000

Choose Your Ink Color

Black
Brown
Burgundy
Green
Orange
Process Blue
Red
Reflex Blue

Add a Second Ink Color

No Second Color
Black [Add $90.00]
Brown [Add $90.00]
Burgundy [Add $90.00]
Orange [Add $90.00]
Process Blue [Add $90.00]
Red [Add $90.00]
Reflex Blue [Add $90.00]

Printing Back Copy One Color

No Back Copy
Print Back Copy Black Ink [Add $90.00]

Numbering

No Numbering
Numbering [Add $55.00]

Staring Number

3 Day Rush Order

No Need To Rush
3 Day Rush Order [Add $175.00]

Qty:

Description

Freight, Returns & Sales Tax Policies

9-1/2" x 11" Three Parts Pinfeed Includes

Custom Print Front
Forms are printed with your choice of codes, descriptions and formats.
Continuous
3 part White 16# CB, Canary 15# CFB & Pink 15# CF
9-1/2â€ x 11â€
Your Choose of One Ink Color - Black, Brown, Burgundy, Green, Orange, Process Blue, Red, Reflex Blue
After Approved Proof Ships in 7 Working Days
Quantities Over 10,000 Ship In 10 Working Days

FREIGHT CHARGES
ACS always confirms to our customers total amount to be charged including freight costs before order
is processed.

RETURNS
There is a 15 day return policy. Customers have 15 days to return products after they have received them. Products are not returnable after this time. Returns are subject to a restocking fee of 25%. If the return is a result of our error, we will issue a call tag. We grant returns on products only if the product and the packaging are in re-sellable condition. Custom products are not returnable.

SALES TAX
ACS charges sales tax if you are a Texas resident, Texas State Sales Tax will be added at the time your
order is invoiced. If you are tax exempt you must provide a Texas Sales Tax Exemption Certificate.