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Home > TOPS Business Forms Inc.


Product Image Item Name - Model Weight Qty. Price

TOPS UB-04 Continuous Hospital Insurance Claim Form, 1 Part, 9.5 x 11 Inches, Removable Margins, 2500 Sheets per Carton, White (59770R)

TOPS UB-04 Continuous Hospital Insurance Claim Form, 1 Part, 9.5 x 11 Inches, Removable Margins, 2500 Sheets per Carton, White (59770R)

59770R 28 5 $84.81
UB-04 1-part continuous is a form that hospitals use to file a claim with the patient's insurance company. Forms are printed to GPO standards in OCR ink on 20 lb. bond. 9.5 x 11 inch size - 2,500 sheets per carton. Replaces UB-92. Meets the...


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