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B95BPERFI05 - 2up Blank 1095-B Form (with Instructions)

B95BPERFI05 - 2up Blank 1095-B Form (with Instructions)

B95BPERFI05
Bulk Pricing:
Buy in bulk and save

Bulk discount rates

Below are the available bulk discount rates for each individual item when you purchase a certain amount

  • Buy 2 - 24 and pay only $0.9700 each
  • Buy 25 - 49 and pay only $0.9700 each
  • Buy 50 - 99 and pay only $0.5120 each
  • Buy 100 - 199 and pay only $0.4610 each
  • Buy 200 - 499 and pay only $0.4260 each
  • Buy 500 - 999 and pay only $0.2800 each
  • Buy 1000 - 1999 and pay only $0.2180 each
  • Buy 2000 - 4999 and pay only $0.2120 each
  • Buy 5000 - 200000 and pay only $0.2020 each

Price per item:

$0.97

Total:

$ 25
Qty: Order a minimum of 25 and in multiples of 25
! Order in multiples of 25

Blank Form 1095-B. Use this blank laser form for printing form 1095-B. Instructions are preprinted on the back. A 1095-B form must be issued by a self-insured employer with less than 50 full-time employees (including full-time equivalent employees), or by the insurer to employees and to the IRS as proof of healthcare coverage. Order by the number of sheets needed.

Note:  Please check your software for 1095 Envelope compatibility.

Specifications:
Construction: Laser Blank
Form: 1095-B
Pages: 1
Size: 8 1/2" x 11"
Forms /Sheet: 2up
Horizontal Perforation: 5 1/2"