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    T004-59870-108315.JPG http://www.oppictures.com/singleimages/100/TOP59870R_1_1.JPG T004-59870.jpg

    UB04 Hospital Insurance Claim Form, 8.5 x 11, 1/Page, 2,500 Forms

    Picture for brand TOPS
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    • Printed to Government Printing Office standards.
    • OCR ink for scanning.
    • American Medical Association (AMA) approved format.
    SKU: T004-59870
    Brand part number: 59870R
    Availability:
    IN STOCK NOW : 14
    Ships in 2-3 DAYS : 48
    Price: Call For Price
    Carton Pack Quantity : 2500EA
    Printed to Government Printing Office standards. OCR ink for scanning. American Medical Association (AMA) approved format.
    Products specifications
    Form Type Details UB04
    Global Product Type Insurance Forms
    Dated/Undated Undated
    Forms Per Page 1
    Form Size 8.5 x 11
    Format Indicator Unbound
    Form Quantity (Total) 2,500
    Copy Types One-Part (No Copies)
    Paper Color(s) White
    Color Family White
    Printer Compatibility Laser
    Paper Stock 20 lb Bond
    Print and Ruling Color(s) Red
    Product Biodegradability in Days 0
    Pre-Consumer Recycled Content Percent 0
    Post-Consumer Recycled Content Percent 0
    Total Recycled Content Percent 0
    Special Features Laser Printer Compatible
    Brand TOPS
    Manufacturer TOPS
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