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TOPS UB-04 Continuous Forms
TOPS UB-04 Continuous Forms - 1 Part - 11" x 9.50" Form Size - Red Print Color - 2500 / Carton
| $201.36 |
Manufacturer:
TOPS Products
Item:
59770R
UPC Code:
025932597701
Our Part #
TOP59770R
Condition
New
$201.36EA
Availability
In Stock
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Product description
UB-04 continuous forms are designed for hospitals 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). Continuous forms are printed on 20 lb. bond paper.
Specifications
Brand Name
TOPS
Brand Name
TOPS
Brand Name
TOPS
Brand Name
TOPS
Color
White
Color
White
Country of Origin
United States
Country of Origin
United States
Country of Origin
United States
Country of Origin
United States
Country of Origin
United States
Environmental Certification
SFI
Environmental Certification
SFI
Environmentally Friendly
Yes
Environmentally Friendly
Yes
Form Length
11"
Form Length
11"
Form Length
11"
Form Length
11"
Form Length
11"
Form Width
9.50"
Form Width
9.50"
Form Width
9.50"
Form Width
9.50"
Form Width
9.50"
Manufacturer
TOPS Products
Manufacturer
TOPS Products
Manufacturer
TOPS Products
Manufacturer
TOPS Products
Manufacturer
TOPS Products
Manufacturer Part Number
59770R
Manufacturer Part Number
59770R
Manufacturer Part Number
59770R
Manufacturer Part Number
59770R
Manufacturer Website Address
http://www.tops-products.com
Manufacturer Website Address
http://www.tops-products.com
Manufacturer Website Address
http://www.tops-products.com
Manufacturer Website Address
http://www.tops-products.com
Number of Parts
1
Number of Parts
1
Number of Parts
1
Number of Parts
1
Number of Parts
1
Packaged Quantity
2500 / Carton
Packaged Quantity
2500 / Carton
Packaged Quantity
2500 / Carton
Packaged Quantity
2500 / Carton
Packaged Quantity
2500 / Carton
Print Color
Red
Print Color
Red
Print Color
Red
Print Color
Red
Print Technology
Dot Matrix
Print Technology
Dot Matrix
Print Technology
Dot Matrix
Print Technology
Dot Matrix
Print Technology
Dot Matrix
Printed Side
Front
Printed Side
Front
Printed Side
Front
Printed Side
Front
Product Model
UB-04
Product Model
UB-04
Product Model
UB-04
Product Model
UB-04
Product Model
UB-04
Product Name
UB-04 Continuous Forms
Product Name
UB-04 Continuous Forms
Product Name
UB-04 Continuous Forms
Product Name
UB-04 Continuous Forms
Product Type
Claim Form
Product Type
Claim Form
Recycled
No
Recycled
No
Brand Name
TOPS
Color
White
Color
White
Color
White
Print Color
Red
Product Type
Claim Form
Product Type
Claim Form
Product Type
Claim Form
Recycled
No
Recycled
No
Recycled
No