

Hero image 0 of TOPS UB-04 Continuous Forms 1 Part - 11" x 9.50" Form Size - White - Red Print Color - 2500 / Carton, 0 of 2
TOPS UB-04 Continuous Forms 1 Part - 11" x 9.50" Form Size - White - Red Print Color - 2500 / Carton
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About this item
- Product Type - Claim Form
- Number Of Parts - 1
- Form Length - 11
- Form Width - 9.50
- Environmentally Friendly - Yes
- Environmental Certification - SFI
- Printed Side - Front
- Country Of Origin - United States
- Recycled - No
- Manufacturer - TOPS Products
- Product Model - UB-04
- Print Color - Red
- Manufacturer Part Number - 59770R
- Manufacturer Website Address - http://www.tops-products.com
- Green Indicator - Y
At a glance
- Count
- 1
- Material
- Plastic
- Sheets
- 2500
- Paper size
- 8-1/2-x-11-inch
- Has written warranty
- No
- Product line
- imageFORMULA
USD$221.95
Free 30-day returns
Price when purchased online
- Free shipping
Free 30-day returns
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Sacramento, 95829
Arrives by Fri, Aug 29
|Sold and shipped by Beach Audio Inc
4.13934034416826 stars out of 5, based on 4184 seller reviews(4.1)4184 seller reviews
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Starting from $216.05
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About this item
Product details
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.
- Product Type - Claim Form
- Number Of Parts - 1
- Form Length - 11
- Form Width - 9.50
- Environmentally Friendly - Yes
- Environmental Certification - SFI
- Printed Side - Front
- Country Of Origin - United States
- Recycled - No
- Manufacturer - TOPS Products
- Product Model - UB-04
- Print Color - Red
- Manufacturer Part Number - 59770R
- Manufacturer Website Address - http://www.tops-products.com
- Green Indicator - Y
info:
We aim to show you accurate product information. Manufacturers, suppliers and others provide what you see here, and we have not verified it. Â
Specifications
Brand
Tops
Manufacturer Part Number
59870R
Model
59770R
Assembled Product Dimensions (L x W x H)
6.10 x 11.80 x 8.70 in
Warranty
Warranty information
Warranty not available for this item
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Please be aware that the warranty terms on items offered for sale by third party Marketplace sellers may differ from those displayed in this section (if any). To confirm warranty terms on an item offered for sale by a third party Marketplace seller, please use the 'Contact seller' feature on the third party Marketplace seller's information page and request the item's warranty terms prior to purchase.
Warnings
Warning Text
proposition 65 reasons:titanium dioxide, other chemicals
Compare with similar items
Product | Viewing this itemTOPS UB-04 Continuous Forms 1 Part - 11" x 9.50" Form Size - White - Red Print Color - 2500 / Carton ![]() $221.95 current price $221.95 | Tops Billing Forms - White - 8.5 in. x 11 in. ![]() $205.05 current price $205.05 | VersaCheck - Form 1000 - Classic - Tan - 2000 Sheets ![]() $199.99 current price $199.99 | Tops Two-part Cms-1500 Forms - 2 Part - Carbonless - 11" X 8.50" Sheet Size - White - 1500 / Carton (50124R) ![]() $128.38 current price $128.38 | CMS 1500 Claim Forms - HCFA (Version 02/12) - 2500 Sheets / CASE ![]() $82.00 current price $82.00 | TOPS 59870R 8.5 in. x 11 in. UB04 Hospital Insurance Claim Form (2500/Carton) ![]() $217.03 current price $217.03 | Linco Standard CMS 1500 claim form, 2500 sheets ![]() $64.42 current price $64.42 | 3-Ply Carbonless Paper, White/Canary/Pink, Form Size 9-1/2" x 3-2/3" W x H Carton of 3150 ![]() $158.70 current price $158.70 |
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Material | PlasticTOPS UB-04 Continuous Forms 1 Part - 11" x 9.50" Form Size - White - Red Print Color - 2500 / Carton | PaperTops Billing Forms - White - 8.5 in. x 11 in. | -VersaCheck - Form 1000 - Classic - Tan - 2000 Sheets | PaperTops Two-part Cms-1500 Forms - 2 Part - Carbonless - 11" X 8.50" Sheet Size - White - 1500 / Carton (50124R) | PaperCMS 1500 Claim Forms - HCFA (Version 02/12) - 2500 Sheets / CASE | PaperTOPS 59870R 8.5 in. x 11 in. UB04 Hospital Insurance Claim Form (2500/Carton) | -Linco Standard CMS 1500 claim form, 2500 sheets | Index StockAccount Billing Cards | -3-Ply Carbonless Paper, White/Canary/Pink, Form Size 9-1/2" x 3-2/3" W x H Carton of 3150 |
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Sheets | 2500TOPS UB-04 Continuous Forms 1 Part - 11" x 9.50" Form Size - White - Red Print Color - 2500 / Carton | 2500Tops Billing Forms - White - 8.5 in. x 11 in. | 2000VersaCheck - Form 1000 - Classic - Tan - 2000 Sheets | 1500Tops Two-part Cms-1500 Forms - 2 Part - Carbonless - 11" X 8.50" Sheet Size - White - 1500 / Carton (50124R) | 2500CMS 1500 Claim Forms - HCFA (Version 02/12) - 2500 Sheets / CASE | 2500TOPS 59870R 8.5 in. x 11 in. UB04 Hospital Insurance Claim Form (2500/Carton) | 2500Linco Standard CMS 1500 claim form, 2500 sheets | 500Account Billing Cards | 31503-Ply Carbonless Paper, White/Canary/Pink, Form Size 9-1/2" x 3-2/3" W x H Carton of 3150 |
Paper size | 8-1/2-x-11-inchTOPS UB-04 Continuous Forms 1 Part - 11" x 9.50" Form Size - White - Red Print Color - 2500 / Carton | 8.5 in. x 11 in.Tops Billing Forms - White - 8.5 in. x 11 in. | letter-sizeVersaCheck - Form 1000 - Classic - Tan - 2000 Sheets | 9-1/2-x-11-inchTops Two-part Cms-1500 Forms - 2 Part - Carbonless - 11" X 8.50" Sheet Size - White - 1500 / Carton (50124R) | 8.5-x-11-inchesCMS 1500 Claim Forms - HCFA (Version 02/12) - 2500 Sheets / CASE | 8.5 in. x 11 in.TOPS 59870R 8.5 in. x 11 in. UB04 Hospital Insurance Claim Form (2500/Carton) | -Linco Standard CMS 1500 claim form, 2500 sheets | -Account Billing Cards | 9-1/2" x 3-2/3"3-Ply Carbonless Paper, White/Canary/Pink, Form Size 9-1/2" x 3-2/3" W x H Carton of 3150 |
Has written warranty | NoTOPS UB-04 Continuous Forms 1 Part - 11" x 9.50" Form Size - White - Red Print Color - 2500 / Carton | NoTops Billing Forms - White - 8.5 in. x 11 in. | NoVersaCheck - Form 1000 - Classic - Tan - 2000 Sheets | Yes - Warranty TextTops Two-part Cms-1500 Forms - 2 Part - Carbonless - 11" X 8.50" Sheet Size - White - 1500 / Carton (50124R) | NoCMS 1500 Claim Forms - HCFA (Version 02/12) - 2500 Sheets / CASE | Yes - Warranty TextTOPS 59870R 8.5 in. x 11 in. UB04 Hospital Insurance Claim Form (2500/Carton) | NoLinco Standard CMS 1500 claim form, 2500 sheets | NoAccount Billing Cards | No3-Ply Carbonless Paper, White/Canary/Pink, Form Size 9-1/2" x 3-2/3" W x H Carton of 3150 |
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