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

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

Environment