Manufacturer | TOPS Products |
Manufacturer Part Number | 59870R |
Brand Name | TOPS |
Product Model | UB-04 |
Product Name | 1-part UB-04 Laser-cut Forms |
Marketing Information | UB-04 laser-cut forms are designed for medical offices to file a claim with the patient's insurance company. The Health Care Finance Administration format ensures accuracy in reporting all necessary information. Forms meet the requirements of the Centers for Medicare and Medicaid Services (CMS). Forms are printed on 20 lb. bond paper. |
Packaged Quantity | 2500 / Carton |
Product Type | Claim Form |
Number of Forms per Sheet | 1 |
Form Length | 11" |
Form Width | 8.50" |
Number of Parts | 1 |
Printed Side | Front |
Print Color | Red |
Print Technology | Laser |
Product Color | White |
Certifications & Standards | American Medical Association |
Recycled | No |
Assembly Required | No |
Environmental Certification | SFI |
Country of Origin | United States |
Catalog Page Number | 588 |
Packing, Level 1 | 1 / EA |
Packing, Level 2 | 2500 EA/CT |
Weight | 26 lbs |
UPSable | |
UPC | 025932598708 |
UNSPSC | 14111804 |
Special Order | No |
Color | WHITE/RED |
Quantity Per Selling Unit | 2500/CT |
Returnable |
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