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Quantity
Number of
Lot Price
50 $16.00 
100 $30.50 
200 $53.36 
300 $64.80 
500 $88.14 
1000 $151.04 
1500 $188.73 
>1500 Call us at
1-800-982-3676
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Self-insured employers with less than 50 full-time employees, or insurers, must issue this form to employees/recipients and submit to the IRS as proof of healthcare coverage. Form 1094-B is the related transmittal.

Be sure to order enough to give to your employees and submit to the IRS.

There are no templates available for this product


Any tax forms ordered today will ship on Tuesday February 07, 2023 if Ground shipping is chosen
They will ship on Monday February 06, 2023 if Express shipping is chosen