Category: Claim/Medical Forms

TOPS 1-part UB-04 Laser-cut Forms - 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton - TOP59870R

TOP59870R
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TOPS 1-part UB-04 Laser-cut Forms - 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton

Overview

General Information

  • Manufacturer
    TOPS Products
  • Manufacturer Part Number
    59870R
  • Manufacturer Website Address
    http://www.tops-products.com
  • 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

Product Information

  • 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
  • Certifications & Standards
    American Medical Association
  • Recycled
    No
  • Assembly Required
    No
  • Environmental Certification
    Sustainable Forestry Initiative (SFI)
  • Country of Origin
    United States

Physical Description

  • Product Color
    White

Shipping

OfficeZilla ships via UPS Ground whenever possible. All orders are shipped to you from the closest of our 30 distribution facilities across the US. Most orders received before 4pm will arrive next day. Not all products are stocked in all distribution centers, so if you need an item urgently, please call and let us check our distribution centers closest to you to ensure we meet your delivery needs. Non UPS-able items are indicated with a “truck” icon on the product detail page. Those items will ship via courier or LTL truck, and *could* take a few extra days to arrive. If you need an item urgently or have special delivery needs, please call us so that we can take special care of you!

Shipments to Alaska, Hawaii and Puerto Rico require special processing and are subject to delivery fees. Please call us at 1-800-699-7549 to arrange delivery outside the continental US.

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