• tops-ub04-hospital-insurance-claim-form-num-top59870r_1
1 1
TOPS™

TOPS™ UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total (TOP59870R)

TOPS™ UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total (TOP59870R)

$311.98
$311.98
/ 1 Carton
Sale Sold out

In stock

This item is non-returnable and may only be returned if item is damaged during shipment or defective.

Estimated Delivery: Mon 6/15 - Wed 6/17 Delivery in 1-2 business days.

Product Specification

  • Printer Compatibility: Laser
  • Layout: One Form per Sheet
  • Format: Loose Form
  • Paper Stock: 20 lb
  • Color: Red, White
  • Product Type: Insurance Claim
  • Dimensions: 8 1/2" x 11"
  • Print and Ruling Color(s): Red
  • Case Pack: 1 Carton
  • Paper Color(s): White
  • Post-Consumer Recycled Content Percent: 0%
  • Pre-Consumer Recycled Content Percent: 0%
  • Total Recycled Content Percent: 0%
  • Global Product Type: Forms-Insurance
  • Form Quantity: 2,500
  • Special Features: For Laser Printers
  • Forms Per Page: 1
  • Form Size: 8.5 x 11
TOPS™ UB04 Hospital Insurance Claim Form
Printed to Government Printing Office standards. OCR ink for scanning. American Medical Association (AMA) approved format.

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
View full details