Return to Prescription Page
Information for Prescription Sheets
TELL US WHO YOU ARE
Practice Name
(If applicable)
Mr/Ms/Mrs
First Name
Last Name
Title/Position
Street Address
City
State
Zip
Telephone
FAX Number
Email Address
Prescription Sheet Design
1000 (Minimum Order)
Quantity
2000 Sheets
More than 2000 sheets
Style
# 222
# 333
Click here to
see sample of
each design
# 444
# 555
Copy to be Printed On Sheets
Street Address
City
State
 Zip
Telephone
WATERMARK:
Tell us what words you want watermarked
on the prescription sheet.
YES
I want my License Number
Printed on the Sheet
NO
YES
I want my DEA Number
Printed on the Sheet
NO
For Security Purposes you will be asked to enter your license numbers
when you Check Out. (Only if you want them printed on the sheets.)
 
This is a TWO STEP Process. After you click the SUBMIT Button, you
will be directed to another page.
YOU MUST USE YOUR 'BACK' BUTTON to RETURN TO THIS
PAGE AND CLICK HERE.
You will be sent to the secure page that allows you to give us your
license numbers and to pay for your order.
 
First Line of Copy: Either Doctor's
Name or Practice Name
Second Line of Copy: Either Doctor's
Specialty or Practice Specialty.
(Or anything else you want to say)
There are two steps to Ordering:  
1. Tell us what you want printed on the Prescription Sheets.
2. "CHECK OUT" This is where you give us your license numbers, and tell us where to ship
your order, etc. (Remember: FREE SHIPPING!)
Chicago WaterMark Company
Personalized Paper
Distinctive
Affordable
Secure
 
 
 
 
106 Years of Excellence