Tops Ub-04 Forms, 1 Part, White, 8 1/2" X 11", Box Of 2,500

SKU: SPY-TOP59870R
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Out of stock
  • Meets the requirements of the Centers for Medicare and Medicaid Services (CMS). Printed on carbonless, 20-lb bond, 1-ply paper with red ink.
Unit Price
Quantity
US$ 244.70
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Brand
Tops
Manufacturer
TOPS BUSINESS FORMS
Features
Double Sided
Manufacturer Part Number
59870R
Packaged Quantity
2500 / Carton
Product Type
Medical Claim Form
Assembly Required
No
Country of Origin
US
Global Product Type
Insurance Forms
Packaging
2500
Post-Consumer Recycled Content Percent
0%
Pre-Consumer Recycled Content Percent
0%
Special Features
Laser Printer Compatible
Total Recycled Content Percent
0%
Recycled
No
Product Line
UB-04 Forms
Environmental Certification
Sustainable Forestry Initiative (SFI)
Certifications & Standards
American Medical Association
Marketing Information
UB-04 laser-cut forms are designed for medical offices to file a claim with the patient's insurance company. Forms are printed to Government Printing Office standards in OCR ink on 20 lb bond.
Product Name
1-part UB-04 Laser-cut Forms
Product Model
UB-04
Sheet Size
Letter (8-1/2" x 11")
Number of Parts
1
Print Technology
Laser
Paper Color(s)
White
Copy Types
One-Part (No Copies)
Form Size
8.5 x 11 8.5 x 11
Forms Per Page
1
Print and Ruling Color(s)
Red
Print Color
Red
Printer Compatibility
Laser
Paper Stock
20 lb Bond
Quantity
2500
Dated/Undated
Undated
Refurbished
N
Form length
11"
Form width
8.50"
Product color
White
Barcode
0818275954726
Description

TOPS UB-04 Forms, 1 Part, White, 8 1/2" x 11", Box Of 2,500 - Used by hospitals and institutions to file a medical claim with a patient's insurance company

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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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