Tops Ub04 Hospital Insurance Claim Form, 8.5 X 11, 1/Page, 2,500 Forms

SKU: SPY-TOP59870R
  • Printed to Government Printing Office standards.
  • OCR ink for scanning.
  • American Medical Association (AMA) approved format.
Unit Price
Quantity
Subtotal
US$ 371.34
US$ 371.34
US$ 369.111%
2
US$ 367.811%
3
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Brand
Print and Ruling Color(s)
Red
Sheet Size
Letter (8-1/2" x 11")
Number of Parts
1
Print Technology
Laser
Paper Color(s)
White
Form Quantity
2,500
Form Size
8.5 x 11 8.5 x 11
Forms Per Page
1
Layout
One Form per Sheet One Form per Sheet
Product Model
UB-04
Print Color
Red
Printer Compatibility
Laser
Paper Stock
20 lb
Refurbished
N
Form length
11"
Form width
8.50"
Product color
White
Pre-Consumer Recycled Content Percent
0%
Manufacturer Part Number
59870R
Packaged Quantity
2500 / Carton
Product Type
Claim Form
Assembly Required
No
Country of Origin
United States
Global Product Type
Forms-Insurance
Packaging
2500
Post-Consumer Recycled Content Percent
0%
Manufacturer
TOPS
Special Features
For Laser Printers
Total Recycled Content Percent
0%
Recycled
No
Product Line
UB-04 Forms
Environmental Certification
SFI
Certifications & Standards
American Medical Association
Product Name
1-part UB-04 Laser-cut Forms
Description

TOPS UB04 Hospital Insurance Claim Form, 8.5 x 11, 1/Page, 2,500 Forms - UB-04 laser-cut forms are designed for medical offices to file a claim with the patient's insurance company. The Health Care Finance Administration format ensures accuracy in reporting all necessary information. Forms meet the requirements of the Centers for Medicare and Medicaid Services (CMS). Forms are printed on 20 lb. bond paper.

Shipping from
This product is shipped from our supplier's warehouse in Colombus, WI, United States
Our guarantee
This product is brand new and includes the manufacturer's warranty, so you can buy with confidence.
A 25% handling charge is levied against all authorized returns except those due to our error. Unauthorized returns are subject to a 40% handling charge. Damages & defects must be reported to us within 14 days.
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