TOPS 1-part UB-04 Laser-cut Forms
$290.24
Sale price
$290.24
Regular price
$343.14
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TOPS 1-part UB-04 Laser-cut Forms
$290.24
Sale price
$290.24
Regular price
$343.14
Order within -- hrs -- min — fulfilled within 24 hours.
1-yr warranty
Bulk pricing
30-day returns
or 4 interest-free payments of $72.56 with Shop Pay
Frequently kitted together
Total for selected:
Specifications
- SKU
- TOP59870R
- Product type
- Claim Form
- Vendor
- TOPS
Full specifications are listed in the product description above.
Compliance & Certifications
- 1-year warranty against manufacturing defects.
Documents
- Safety Data Sheet (SDS) available on request — contact us.
Shipping & Returns
- In-stock orders are fulfilled within 24 hours (business days).
- 30-day returns on unused items in original packaging.
- Bulk and freight options available — request a bulk quote.
Order within -- hrs -- min — fulfilled within 24 hours.
or 4 interest-free payments of $72.56 with Shop Pay
1-yr warranty
Bulk pricing
30-day returns
Meet the TOPS 1-part UB-04 Laser-cut Forms: built for everyday classroom, office, and event use.
1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton
Why you'll love it
- Continuous forms are designed for hospitals to file a claim with the patient's insurance company
- Forms are printed to GPO standards in OCR ink on 20 lb. bond
- Health Care Finance Administration format ensures accuracy in reporting all necessary information
- 11" Length x 8.50" Width; 2500 / Carton
Product details
Brand: TOPS
Category: Claim Form
Sold as: 2500 / Carton
Item #: TOP59870R
Supplied by Ed & Leute LLC — your trusted supplier for schools, offices, and businesses. Reliable fulfillment and friendly service on every order.
Trusted Government & Agency Supplier
GSA Contract 47QSWA23D002RSDVOSB · Veteran-OwnedAbilityOne AuthorizedCAGE 7Z9F4
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