TOPS UB-04 Continuous Forms - 1 Part - 11" x 9.50" Form Size - Red Print Color - 2500 / Carton

TOP59770R

UB-04 continuous forms are designed for hospitals 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). Continuous forms are printed on 20 lb. bond paper.

General Information

Manufacturer: TOPS Products
Manufacturer Part Number: 59770R
Manufacturer Website Address: http://www.tops-products.com
Product Model: UB-04
Product Name: UB-04 Continuous Forms
Packaged Quantity: 2500 / Carton

Product Information

Number of Forms per Sheet: 1
Form Length: 11"
Form Width: 9.50"
Number of Parts: 1
Printed Side: Front
Print Color: Red
Print Technology: Dot Matrix

Physical Characteristics

Color: White

Miscellaneous

Environmentally Friendly: Yes
Environmental Certification: SFI

Full Color Printing

Wide Format Printing