Centers for Medicare and Medicaid Services Forms, Two-Part, 1500 Forms

Item #: TOP50124RV
by TOPS™
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Product Details

Centers for Medicare and Medicaid Services Forms, Two-Part, 1500 Forms

Expedite Medicare, Medicaid or private insurance benefits. NUCC, CMS and AMA approved format. (02/12) version. Printed front and back in red OCR ink for scanning.


Product Specifications

Item Specifications
Brand TOPS™
Global Product Type Forms-Insurance
Form Size 8 1/2 x 11
Forms Per Page 1
Form Quantity 1500
Principal Heading(s) 1500 Health Insurance Claim Form
Layout One Form per Sheet
Copy Types Two-Part Carbonless
Punching Dot Matrix Pin Feed Holes
Printer Compatibility Dot Matrix
Paper Stock 20-lb.
Paper Color(s) White
Print and Ruling Color(s) OCR Red
Pre-Consumer Recycled Content Percent 0%
Post-Consumer Recycled Content Percent 0%
Total Recycled Content Percent 0%
Footnote 1 Carbonless Duplicate
Special Features Carbonless Duplicate

Dimensions / Specifications
Unit of Measure CT
Item Weight 31.000 lbs
Ships via UPS? Yes
Carton Pack Quantity 1500 ST
This item is sold by the CT which contains 1500 ST
Manufacturer Info
Brand TOPS™
Manufacturer Stock No. 50124RV
Staples Equivalent SKU 2408491
Retail UPC 025932512407
Country of Origin US
UNSPSC Number 14111806
Meets ANSI/BIFMA? 025932512407
OTS Product ID 9472549

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Document printed / saved on 05/21/2018. Prices subject to change.