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TOPS UB04 Hospital Insurance Claim Form, 8 1/2 x 11, Laser Printer, 2500 Forms
TOPS UB04 Hospital Insurance Claim Form, 8 1/2 x 11, Laser Printer, 2500 Forms

UB04 Hospital Insurance Claim Form, 8 1/2 x 11, Laser Printer, 2500 Forms

Item #: TOP59870R

$207.49/1 Carton

Estimated Delivery: Tue 7/5 to Wed 7/6
Free Standard Shipping over $149
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Product Details

Printed to Government Printing Office standards. OCR ink for scanning. American Medical Association (AMA) approved format.


COLOR: Red, White
ALTERNATE ITEM #: 526935, 811021, B001E662W4

UPC: 025932598708

ITEM #: TOP59870R

Product Type: General Forms

Red, White General Forms 189 In Stock today.
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Product Specifications

Case Pack
1 Carton
Color
Red, White
Dimensions
8 1/2" x 11"
Form Quantity
2,500
Form Size
8.5 x 11
Format
Loose Form
Forms Per Page
1
Global Product Type
Forms-Insurance
Layout
One Form per Sheet
Manufacturer Name
TOPS
Paper Color(s)
White
Paper Stock
20 lb
Post-Consumer Recycled Content Percent
0%
Pre-Consumer Recycled Content Percent
0%
Print and Ruling Color(s)
Red
Printer Compatibility
Laser
Product Type
Insurance Claim
Special Features
For Laser Printers
Total Recycled Content Percent
0%
Weight
26 lb(s)
TOPS UB04 Hospital Insurance Claim Form, 8 1/2 x 11, Laser Printer, 2500 Forms (TOP59870R)