Are you printing your statements out on copy paper? Here’s a better alternative!

For less than 5 cents a piece this perforated colored laser statement paper will create a professional image while making it easy for patients to tear off the remit portion and send in their payment. Accept credit cards? Make sure your patients know. For a nominal fee we can pre-print credit card information on the back of the laser statement paper, with “SEE REVERSE SIDE FOR CREDIT CARD PAYMENT” on the front.

We can also create a statement that looks just like this, but with your logo printed at the top and/or screened in the statement section.  Call for quote.  Remittance envelopes and single or double window outer envelopes compatible with your software program are also available.

8-1/2 x 11, horizontal perforation 3-2/3” from top, 24# bond paper, 1000 per carton.

This form is available in teal, yellow, blue, maroon, green and lavender. To view the other colors and compatible envelopes, please see the related products below.

We can customize any form.  Call or email for quote.

Pricing and Customization (If Applicable)
Product #	2196
Imprint?	No Yes
M	0.5 ($104.00 Per M) 1 ($71.00 Per M) 1.5 ($67.00 Per M) 2 ($70.00 Per M) 2.5 ($68.00 Per M) 3 ($63.00 Per M) 3.5 ($62.00 Per M) 4 ($62.00 Per M) 4.5 ($57.00 Per M) 5 ($55.00 Per M) 6 ($55.00 Per M) 7 ($55.00 Per M) 8 ($55.00 Per M) 9 ($55.00 Per M) 10 ($55.00 Per M) 1,000 per M
Imprinted (M)	0.5 ($138.00 Per M) - Imprinted - 1 Side 1 ($106.00 Per M) - Imprinted - 1 Side 1.5 ($102.00 Per M) - Imprinted - 1 Side 2 ($105.00 Per M) - Imprinted - 1 Side 2.5 ($102.00 Per M) - Imprinted - 1 Side 3 ($92.00 Per M) - Imprinted - 1 Side 3.5 ($92.00 Per M) - Imprinted - 1 Side 4 ($92.00 Per M) - Imprinted - 1 Side 4.5 ($92.00 Per M) - Imprinted - 1 Side 5 ($90.00 Per M) - Imprinted - 1 Side 6 ($90.00 Per M) - Imprinted - 1 Side 7 ($90.00 Per M) - Imprinted - 1 Side 8 ($90.00 Per M) - Imprinted - 1 Side 9 ($90.00 Per M) - Imprinted - 1 Side 10 ($90.00 Per M) - Imprinted - 1 Side 0.5 ($158.00 Per M) - Imprinted - 2 Side 1 ($126.00 Per M) - Imprinted - 2 Side 1.5 ($123.00 Per M) - Imprinted - 2 Side 2 ($125.00 Per M) - Imprinted - 2 Side 2.5 ($116.00 Per M) - Imprinted - 2 Side 3 ($113.00 Per M) - Imprinted - 2 Side 3.5 ($113.00 Per M) - Imprinted - 2 Side 4 ($113.00 Per M) - Imprinted - 2 Side 4.5 ($113.00 Per M) - Imprinted - 2 Side 5 ($111.00 Per M) - Imprinted - 2 Side 6 ($111.00 Per M) - Imprinted - 2 Side 7 ($111.00 Per M) - Imprinted - 2 Side 8 ($111.00 Per M) - Imprinted - 2 Side 9 ($111.00 Per M) - Imprinted - 2 Side 10 ($111.00 Per M) - Imprinted - 2 Side 1,000 per M
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