| Quantity Number of | Lot Price |
| 25 | $37.50 |
| 50 | $61.25 |
| 100 | $86.25 |
| 200 | $133.75 |
| 300 | $175.00 |
| 500 | $251.25 |
| >500 | Call us at 1-800-982-3676 or Email Us For Price |
Use this transmittal as a coversheet when submitting each batch of form 1095-C to the IRS. This kit contains all 3 pages of the transmittal.