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TOPS UB-04 Forms, 1 Part, White, 8 1/2" x 11", Box Of 2,500

1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton
Product Number: TOP59870R
  • Meets the requirements of the Centers for Medicare and Medicaid Services (CMS). Printed on carbonless, 20-lb bond, 1-ply paper with red ink.
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$203.94
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Delivered by Fri 4/26 Mon 4/29 - This is an estimated delivery timeline
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Product 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

  • Meets the requirements of the Centers for Medicare and Medicaid Services (CMS). Printed on carbonless, 20-lb bond, 1-ply paper with red ink.
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Product Specifications

  • Assembly Required
    No
  • Brand Name
    Tops
  • Certifications & Standards
    American Medical Association
  • Copy Types
    One-Part (No Copies)
  • Country of Origin
    US
  • Dated/Undated
    Undated
  • Environmental Certification
    Sustainable Forestry Initiative (SFI)
  • Features
    Double Sided
  • Form Length
    11"
  • Form Size
    8.5 x 11 8.5 x 11
  • Form Width
    8.50"
  • Forms Per Page
    1
  • Global Product Type
    Insurance Forms
  • Manufacturer
    TOPS BUSINESS FORMS
  • Manufacturer Part Number
    59870R
  • Manufacturer Website Address
    www.tops-products.com
  • 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.
  • Number of Holes Punched
    0
  • Number of Parts
    1
  • Packaged Quantity
    2500 / Carton
  • Packaging
    2500
  • Paper Color(s)
    White
  • Paper Stock
    20 lb Bond
  • Post-Consumer Recycled Content Percent
    0%
  • Pre-Consumer Recycled Content Percent
    0%
  • Print Color
    Red
  • Print Technology
    Laser
  • Print and Ruling Color(s)
    Red
  • Printer Compatibility
    Laser
  • Product Color
    White
  • Product Line
    UB-04 Forms
  • Product Model
    UB-04
  • Product Name
    1-part UB-04 Laser-cut Forms
  • Product Type
    Medical Claim Form
  • Quantity
    2500
  • Recycled
    No
  • Refurbished
    N
  • Sheet Size
    Letter (8-1/2" x 11")
  • Special Features
    Laser Printer Compatible
  • Total Recycled Content Percent
    0%
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