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Office Forms, Recordkeeping & Reference Materials Forms & Recordkeeping Systems Medical & Insurance Forms TOPS TOP59870R

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

Item # TOP 59870R by TOPS (Mfg. Part # TOP59870R, UPC # 25932598708)


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


  • Quantity : 2500 per Carton

  • Form Size : 8 1/2 x 11

  • Forms Per Page : 1

  • Layout : One Form per Sheet

  • Printer Compatibility : Laser

  • Paper Stock : 20-lb.

  • Paper Color : Red, White

  • Print and Ruling Color : Red

  • Special Features : For Laser Printers

TOP59870R - TOPS® UB04 Hospital Insurance Claim Form
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Retail Price: $157.01
BettyMills Discount Price: $116.30 Per Carton
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