All orders will be shipped by UPS Standard Ground Delivery unless other shipping arrangements are required.  Prices quoted do not include freight or any applicable sales tax.
YOU MAY ALSO ORDER BY PHONE TOLL FREE AT:
1-877-840-1500
Our Office Hours are 8-5 Mon.-Fri. CST
OR USE OUR PRINT AND FAX ORDER FORM

DIRECT ON-LINE ORDER FORM

Company Name

 

Your Name

If you have ordered from us before, just fill in your name,company name and products ordered.

Street Address

 

City

 

State

 

Zip Code

 

Phone/Ext.

 

E-Mail (required)

 

Fax

CHOOSE ONE OR SEND ORDER FORM AND CALL
TOLL FREE  1-877-840-1500 TO GIVE CARD NUMBER

 

Credit Card Number

 

Expiration Date

For prices and carton quantities, return to Home page HERE.

Form Name      # Cartons Ordered

HCFA 1500 Continuous-1 Part-bar coded

 

HCFA 1500 Continuous -1 Part-non bar coded

 

HCFA 1500 Continuous-2 Part-bar coded

 

HCFA 1500 Continuous-2 Part-non bar coded

 

HCFA 1500 Laser-bar coded

 

HCFA 1500 Laser-non bar coded

 

HCFA 1500 Snapout Version

 

UB 92 Continuous-1 Part

 

 UB 92 Continuous-2 Part

 

UB 92 Continuous-3 Part

 

UB 92 Continuous-4 Part

 

UB 92 Laser

 

ADA 2000 Dental Claim Form Continuous - 1 Part

 

ADA 2000 Dental Claim Form Continuous - 2 Part

 

ADA 2000 Dental Claim Form Laser

 

ADA 94 Dental Claim Form Continuous - 1 Part

 

ADA 94 Dental Claim Form Continuous - 2 Part

 

ADA 94 Dental Claim Form Laser

 

HCFA 485 4 Part Continuous

 

HCFA 486 3 Part Continuous

 

HCFA 487 4 Part Continuous

 

Claim Form Envelopes #10.5 Right Hand Window

 

Claim Form Envelopes #9x12.5 Right Hand Window

 

Claim Form Envelopes #9x12.5 Left Hand Window

 

HCFA 485 Claim Form

 

HCFA 486 Claim Form

 

HCFA 487 Claim Form

 

 Click Here to Send Order  >>>

YOU MAY ALSO ORDER BY PHONE TOLL FREE AT:
1-877-840-1500
Our Office Hours are 8-5 Mon.-Fri. CST

Medical Insurance Claim Forms
 Division of:
DFL Enterprises, Inc.
124 Pine Oak Dr.
Covington, LA  70433

PHONE:  985-875-0800
E-MAIL: sales@claimformsdepot.com