UB04 Hospital Insurance Claim Form, 8 1/2 x 11, Laser Printer, 2500 Forms

Item #: TOP59870R
by TOPS™
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Nationwide Stock: 90 CT
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Product Details

UB04 Hospital Insurance Claim Form, 8 1/2 x 11, Laser Printer, 2500 Forms

Printed to Government Printing Office standards. OCR ink for scanning. American Medical Association (AMA) approved format.


Product Specifications

Item Specifications
Brand TOPS™
Global Product Type Forms-Insurance
Form Size 8 1/2 x 11
Forms Per Page 1
Form Quantity 2500
Layout One Form per Sheet
Printer Compatibility Laser
Paper Stock 20-lb.
Paper Color(s) Red, White
Print and Ruling Color(s) Red
Pre-Consumer Recycled Content Percent 0%
Post-Consumer Recycled Content Percent 0%
Total Recycled Content Percent 0%
Special Features For Laser Printers

Dimensions / Specifications
Unit of Measure CT
Item Weight 26.000 lbs
Ships via UPS? y
Carton Pack Quantity 2500 EA
This item is sold by the CT which contains 2500 EA

Catalog Information
Catalog Page No.'s EVERYTHING FOR THE WORKPLACE 2014: Page 967
EVERYTHING FOR THE WORKPLACE 2015: Page 983
EVERYTHING FOR THE WORKPLACE NON-VIRTUAL 2015: Page 983
EVERYTHING FOR THE WORKPLACE NON-VIRTUAL 2016: Page 979
EVERYTHING FOR THE WORKPLACE NON-VIRTUAL 2017: Page 911
Manufacturer Info
Brand TOPS™  (website)
Brand Contact 800-282-7261
Manufacturer Stock No. 59870R
Retail UPC 025932598708
Country of Origin US
Tariff (Inbound) Code
UNSPSC Number 14111806
Meets ANSI/BIFMA? 025932598708
OTS Product ID 9461823

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Document printed / saved on 11/19/2017. Prices subject to change.