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September 8th, 2008

Insurance/UB04 Hospital Claim Form, 8-1/2 x 11, 2500 Loose Forms/Carton


  Home  »  Forms, Record Keeping & Reference  »  Human Resources  »  Personnel Forms  »  TOPS UB04 Hospital Insurance Claim Form

TOP59870R Insurance/UB04 Hospital Claim Form, 8-1/2 x 11, 2500 Loose Forms/Carton

SKU NumberTOP59870R
Our Price$119.22 / CT
List Price$155.75
Qty in Stock151     Item stock
Item weight26.000 lbs.
CT     Add to Cart
Ships same day via UPS
 
Ships same day via UPS Rush Delivery Available


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  Overview   Product Specifications   Reviews   Similar Products    
Printed to Government Printing Office standards. OCR ink for scanning. American Medical Association (AMA) approved format. Form Type: Insurance Claim; Format: Loose Form; Form Size: 8 1/2 x 11; Sheet Size: 8 1/2 X 11.
Product Attributes
Form Size8 1/2 x 11
Form TypeInsurance Claim
FormatLoose Form
LayoutOne Form per Sheet
Paper Color(s)Red, White
Paper Stock20-lb.
Post-Consumer Recycled Content Percent [Nom]0 %
Pre-Consumer Recycled Content Percent [Nom]0 %
Print and Ruling Color(s)Red
Printer CompatibilityLaser
Sheet Size8 1/2 X 11
Total Recycled Content Percent [Nom]0 %


Product Dimensions / Packaging
Item Weight26.000 lbs
Unit of MeasureCT
Carton Quantity2500 EA
Ships via UPSY


Manufacturer Information
BrandTOPS
Manufacturer Stock No.59870R
UPC Class Code00025932598708
Country of OriginUS
Tariff Code
UNSPSC Number14111806
Meets ANSI/BIFMA
Manufacturer Websitewww.tops-products.com
Manufacturer Phone800-621-1291


Miscellaneous Information
Legacy DescriptionFORM,UB-04,1-PT,LASER,WE
KeywordsClaim Form;Claim Forms;Continuous Form;HCFA Claim Form;Health Care Claim Forms;Human Resources;Insurance Forms;Personnel;Personnel Forms;TOPS;UB04
Catalog Page918
Office Depot SKU:TOP59870


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