TOPS UB-04 Continuous Forms
New
TOPS UB-04 Continuous Forms - 1 Part - 11" x 9.50" Form Size - Red Print Color - 2500 / Carton
| $179.06 Retail $201.36 |
Extended Warrenty
| 1 Year Extended Warrenty | $17.08 |
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UB-04 continuous forms are designed for hospitals 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). Continuous forms are printed on 20 lb. bond paper.
Product Specifications
| Brand Name | TOPS |
| Color | White |
| Country of origin | United States |
| Environmental Certification | SFI |
| Environmentally Friendly | Yes |
| Form Length | 11" |
| Form Width | 9.50" |
| Manufacturer Part Number | 59770R |
| Manufacturer Website Address | http://www.tops-products.com |
| Number of Parts | 1 |
| Packaged Quantity | 2500 / Carton |
| Print Color | Red |
| Print technology | Dot Matrix |
| Printed Side | Front |
| Product Model | UB-04 |
| Product Name | UB-04 Continuous Forms |
| Recycled | No |
| Manufacturer | TOPS Products |
| Product Type | Claim Form |
Material Safety Data Sheet
A Material Safety Data Sheet (MSDS) is a document that contains information on the potential hazards (health, fire, reactivity and environmental) and how to work safely with the chemical product.
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