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TOPS™ UB04 Hospital Insurance Claim Form

Name: TOPS™ UB04 Hospital Insurance Claim Form
Brand: TOPS™
Availability: Discontinued

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

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Prices and Availability Subject to Change

Product Number

Details

Price

Quantity

TOP59870R-337553

Global Product Type: Forms-Insurance Claim	Form Size: 11 x 8 1/2
Forms Per Page: 1	Form Quantity: 2500
Layout: One Form per Sheet	Printer Compatibility: Laser
Paper Stock: 20-lb.	Paper Color(s): White
Print and Ruling Color(s): Red	Form Special Features: For Laser Printers
Pre-Consumer Recycled Content Percent: 0%	Post-Consumer Recycled Content Percent: 0%
Total Recycled Content Percent: 0%	Special Features: For Laser Printers

N/A

Unavailable


*Company:
*Name:
*Email:
*Phone:
*Address:
*City:
*State:
*Ship to Zip code:
*Location type:
*Do you have a forklift or Loading Dock? Yes No
*Do you Require a call to Schedule Delivery? Yes No


*Company:
*Name:
*Email:
*Phone:
Address:
City:
State:
Ship to Zip code:
Location type:
Do you have a forklift or Loading Dock? Yes No
Do you Require a call to Schedule Delivery? Yes No