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UB04 Hospital Insurance Claim Form, 8 1/2 x 11, 2,500 Forms
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TOPS™

TOPS™ UB04 Hospital Insurance Claim Form, 8 1/2 x 11, 2,500 Forms

Item: TOP59870R

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  • Printed to Government Printing Office standards.
  • OCR ink for scanning.
  • American Medical Association (AMA) approved format.
$214.49
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Made In The USA
  • Product Details
  • Description
  • Warranty Information
Form Size: 8 1/2 in x 11 in   Format: Loose Form  
Form Type: Insurance Claim   Layout: One Form per Sheet  
Paper Color(s): Red   Paper Color(s): White  
Paper Stock: 20-lb.   Post-Consumer Recycled Content Percent [Nom]: 0 %  
Pre-Consumer Recycled Content Percent [Nom]: 0 %   Print and Ruling Color(s): Red  
Printer Compatibility: Laser   Punching: Unpunched  
Sheet Size: 8 1/2 x 11   Total Recycled Content Percent [Nom]: 0 %  

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