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

CT (Carton of 2,500)

NSN/SKU: TOP59870R
Regular priceYour Price: $221.00 / CT ($0.08 each)
Free Shipping on orders over $75
Est. Lead Time: Usually ships in 2-3 business days

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.

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


Product Details

SKU: TOP59870R
Manufacturer: TOPS BUSINESS FORMS
Mfr. Part Number: 59870R
Brand Name: TOPS
Alternate Part Numbers: TOP59870R, TOP-59870R, 59870R, 50025932598703 (GTIN), 00025932598708 (GTIN)
Country of Origin: US (United States)
TAA Compliant: Yes
UNSPSC Code: 0014111806
Unit of Measure: CT (Carton of 2,500)
UPS Shippable: Yes
Air Shippable: Yes
Item Dimensions: 12.00 in. x 9.25 in. x 10.25 in.
Shipped Dimensions: 12.00 in. x 9.25 in. x 10.25 in.
Weight: 26.0000 lb.
Expiration Date: No

Environmental Properties

Green Indicator: No
Recycled: No