TOPS™ UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total

TOPS™ UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total

Item # TOP59870R

  • Printed to Government Printing Office standards.
  • OCR ink for scanning.
  • American Medical Association (AMA) approved format.
Alternate #59870R
Your Price:
$433.16/CT

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

Laser Printer Compatible. Form Type Details: UB04; Dated/Undated: Undated; Forms Per Page: 1; Form Size: 8.5 x 11.

  • Global Product Type Insurance Forms
  • Form Type Details UB04
  • Dated/Undated Undated
  • Forms Per Page 1
  • Form Size 8.5 x 11
  • Format Indicator Unbound
  • Form Quantity (Total) 2,500
  • Copy Types One-Part (No Copies)
  • Paper Color(s) White
  • Color Family White
  • Printer Compatibility Laser
  • Paper Stock 20 lb Bond
  • Print and Ruling Color(s) Red
  • Product Biodegradability in Days 0
  • Pre-Consumer Recycled Content Percent 0%
  • Post-Consumer Recycled Content Percent 0%
  • Total Recycled Content Percent 0%
  • Special Features Laser Printer Compatible
  • Country of Origin US
  • Carton Pack Quantity 2500
  • Pack Quantity 0
  • UPC 025932598708
  • UNSPSC 14111806