bmPrintHeader
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 # 025932598708)


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
Click to Enlarge
Retail Price: $157.01
BettyMills Discount Price: $116.30 Per Carton
Quantity   
Order 3+ and Save an Extra $2.33 Per Carton
I'd Like a Volume Quote for TOP59870R



Betty Mills Also Suggests for TOP59870R
TOPS TOPS® Centers for Medicare and Medicaid Services (CMS) Forms TOP50122RV $110.66
Per Carton
TOPS® Centers for Medicare and Medicaid Services (CMS) Forms
TOP 50122RV
TOPS TOPS® Centers for Medicare and Medicaid Services (CMS) Forms TOP50124RV $130.83
Per Carton
TOPS® Centers for Medicare and Medicaid Services (CMS) Forms
TOP 50124RV
TOPS TOPS® Centers for Medicare and Medicaid Services (CMS) Forms TOP50126RV $27.27
Per Pack
TOPS® Centers for Medicare and Medicaid Services (CMS) Forms
TOP 50126RV
Paris Business Products Paris Business Products Insurance Forms PRB04104 $11.72
Per Ream
Paris Business Products Insurance Forms
PRB 04104
Paris Business Products Paris Business Products Insurance Forms PRB04106 $21.42
Per Ream
Paris Business Products Insurance Forms
PRB 04106
Prescription Required !

Unless you are a licensed care provider or similar
qualified entity, a prescription is required
to purchase this item.

Thanks! -- Betty Mills




Email:



Password :





  Forgot Password?
  Create an Account