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Insurance/UB04 Hospital Claim Form, 8-1/2 x 11, 2500 Loose Forms/Carton

  • Printed to Government Printing Office standards. OCR ink for scanning. American Medical Association (AMA) approved format. Form Type: Insurance Claim; Format: Loose Form; Form Size (W x H): 8 1/2 in x 11 in; Sheet Size (W x H): 8 1/2 in x 11 in.
  • Usually arrives in 1-2 business days
  • Brand: TOPS®
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Item# Description Price Unit Stock Ship Order
TOP59870R (26.0 lbs) $155.75 $125.30 (save 19%) Carton 184 Ship via UPS
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Specifications
Form Size (W x H) 8 1/2 in @ 11 in
Form Type Insurance Claim
Format Loose Form
Layout One Form per Sheet
Paper Color(s) Red, White
Paper Stock 20-lb.
Print and Ruling Color(s) Red
Printer Compatibility Laser
Sheet Size (W x H) 8 1/2 in @ 11 in
UOM from Inventory Unit Code CT
Product Information
United Nations Product Code 14111806
Country of origin US
Keywords Claim Form, Claim Forms, Continuous Form, HCFA Claim Form, Health Care Claim Forms, Human Resources, Insurance Forms, Personnel, Personnel Forms, TOPS, UB04
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TOP59770R (28.0 lbs) $146.19 $117.60 (save 19%) Carton 141 Ship via UPS
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