Tops TOP 59870R 1part Ub04 Lasercut Forms 1 Part 11 X 8.50 Form Size

SKU: E70R9C4PO1 |  Mfg. Part: TOP 59870R
In Stock (71)

Special Price $219.87 Regular Price $296.82 

Condition: New
Model Number: TOP 59870R

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TOPS 1-part UB-04 Laser-cut Forms

General Information
Manufacturer:TOPS Products
Manufacturer Part Number:59870R
Manufacturer Website Address:
Brand Name:TOPS
Product Model:UB-04
Product Name:1-part UB-04 Laser-cut Forms
Marketing Information:

UB-04 laser-cut forms are designed for medical offices to file a claim with the patient's insurance company. The Health Care Finance Administration format ensures accuracy in reporting all necessary information. Forms meet the requirements of the Centers for Medicare and Medicaid Services (CMS). Forms are printed on 20 lb. bond paper.

Packaged Quantity:2500 / Carton
Product Type:Claim Form
Product Information
Number of Forms per Sheet:1
Form Length:11"
Form Width:8.50"
Number of Parts:1
Printed Side:Front
Print Color:Red
Print Technology:Laser
Physical Characteristics
Certifications & Standards:

American Medical Association

Assembly Required:No
Environmentally Friendly:Yes
Environmental Certification:SFI
Country of Origin:United States

Mfg#: TOP 59870R
Updated: Jul 02, 2022
Added: Dec 02, 2021
Wt: 26.00 lbs

More Info:

  • Updated:
  • Added:
  • Weight:
  • UPC:
  • Condition:
  • Manufacturer:
  • Mfg#:
  • Jul 02, 2022
  • Dec 02, 2021
  • 26.00lbs
  • 000000000000
  • New
  • TOPS
  • TOP 59870R

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Tops TOP 59870R 1part Ub04 Lasercut Forms 1 Part 11 X 8.50 Form Size
TOP 59870R








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