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Tops® Laser UB-04 Claim Forms, 1-Part, 8-1/2" x 11", White, 2500 Forms/Carton
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Tops® Laser UB-04 Claim Forms, 1-Part, 8-1/2" x 11", White, 2500 Forms/Carton

Item #: WBB859394

Sold By: globalindustrial.com

Ships same day. Estimated lead times do not include weekends or holidays. Transit time is determined by shipping method and destination. Orders requiring credit information might take additional time.

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List Price: $198.36 Save up to 29%
Price: $ 140.95

with FREE shipping today! (within the contiguous US)

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Tops® Laser UB-04 Claim Forms, 1-Part, 8-1/2" x 11", White, 2500 Forms/Carton

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.


This product arrives to most customers in 2-3 business days.

Product Specifications

    • WIDTH INCHES8-1/2
    • HEIGHT INCHES11
    • COLOR FINISHWhite
    • CONSTRUCTIONPaper
    • BRANDTops®
    • DESCRIPTIONLaser UB-04 Claim Form
    • MANUFACTURERS PART NUMBER59870R
    • PACKAGE QUANTITY2500 Forms/Carton
    • PAPER TYPEForms
    • STYLEMedical Form

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