Printed to Government Printing Office standards. OCR ink for scanning. American Medical Association (AMA) approved format. Laser Printer Compatible. Form Type Details: UB04; Dated/Undated: Undated; Forms Per Page: 1; Form Size: 8.5 x 11.
- Printed to Government Printing Office standards.
- OCR ink for scanning.
- American Medical Association (AMA) approved format.
Product Details
| SKU: | TOP59870R |
| Manufacturer: | TOPS BUSINESS FORMS |
| Mfr. Part Number: | 59870R |
| Brand Name: | TOPS |
| Alternate Part Numbers: | TOP59870R, TOP-59870R, 59870R, 50025932598703 (GTIN), 00025932598708 (GTIN) |
| Country of Origin: | US (United States) |
| TAA Compliant: | Yes |
| UNSPSC Code: | 0014111806 |
| Unit of Measure: | CT (Carton of 2,500) |
| UPS Shippable: | Yes |
| Air Shippable: | Yes |
| Item Dimensions: | 12.00 in. x 9.25 in. x 10.25 in. |
| Shipped Dimensions: | 12.00 in. x 9.25 in. x 10.25 in. |
| Weight: | 26.0000 lb. |
| Expiration Date: | No |
| Keywords: | Claim Form; Claim Forms; Continuous Form; HCFA Claim Form; Health Care Claim Forms; Human Resources; Insurance Forms; Personnel; Personnel Forms; TOPS; UB04; Paperwork; Records; Documents; Pre-Printed; Record-Keeping |
Environmental Properties
| Green Indicator: | No |
| Recycled: | No |
