Material Handling Solutions Llc Material Handling Solutions Llc
4001 S Shary Rd Ste 550
Mission, TX 78572

Phone: 956-465-4177
Fax: 206-984-3770

Tops® Ub04 Hospital Insurance Claim Form printable version

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

Click on the Product No(s). below to view further information and order now!


Product No. TOP59870R
Global Product Type Forms-Insurance Claim
Form Type Insurance Claim
Format Loose Form
Form Size (W x H) 8 1/2 in x 11 in
Form Size 8 1/2 x 11
Forms Per Page 1
Sheet Size 8 1/2 X 11
Form Quantity 2500
Layout One Form per Sheet
Punching
Printer Compatibility Laser
Paper Stock 20-lb.
Paper Color(s) White
Print and Ruling Color(s) Red
Form Special Features For Laser Printers
Pre-Consumer Recycled Content Percent 0 %
Post-Consumer Recycled Content Percent 0 %
Total Recycled Content Percent 0 %
Price
CT$186.97


Product No. TOP59770R
Global Product Type
Form Type Insurance Claim
Format Continuous Form
Form Size (W x H)
Form Size 8 1/2 x 11
Forms Per Page
Sheet Size
Form Quantity
Layout One Form per Sheet
Punching Dot Matrix Holes
Printer Compatibility Dot Matrix
Paper Stock 20-lb.
Paper Color(s) White
Print and Ruling Color(s) Red
Form Special Features
Pre-Consumer Recycled Content Percent 0 %
Post-Consumer Recycled Content Percent 0 %
Total Recycled Content Percent 0 %
Price
CT$139.23