Blank 1095 Form

(B95BLANK)
Blank 1095-B form, 8 ½ x 11 with a horizontal fold perf at 5 ½ inches meant to print a recipient 1095 on the top half and the instructions on the bottom. Compatible with 95DWENV05 and 95DWENVS05.
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Quantity / Unit Price
1 / Free Sample
25 - 49 / $0.624
50 - 99 / $0.371
100 - 199 / $0.334
200 - 499 / $0.309
500 - 999 / $0.1928
1000 - 1999 / $0.1724
2000 - 4999 / $0.1673
5000+ / $0.1591
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First Text
Minimum order of 25
or increments of 25
$000.00