TOPS UB-04 Hospital Claim Form - 1 Part - 11" x 8.50" Form Size - Red Print Color - 2500 / Carton 59870R
59870R | Tops®
Part Number: 59870R
Unit: CT
Condition: New
Stock: 19
Real time availability
Product Specifications
TOPS UB-04 Hospital Claim Form - 1 Part - 11" x 8.50" Form Size - Red Print Color - 2500 / Carton 59870R
UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5
Manufacturer Part Number: 59870R
MANUFACTURER NAME: Tops
MANUFACTURER PART NUMBER: 59870R
UPC EAN CODE: 818275954726
LANGUAGE: EN
MARKET:US
General Information: | |
UB-04 laser-cut forms are designed for medical offices 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). Forms are printed on 20 lb. bond paper. | |
Manufacturer | TOPS Products |
Manufacturer Part Number | 59870R |
Manufacturer Website Address | http://www.tops-products.com |
Brand Name | TOPS |
Product Model | UB-04 |
Product Name | 1-part UB-04 Laser-cut Forms |
Packaged Quantity | 2500 / Carton |
Product Type | Claim Form |
Product UPC | 818275954726 |
Product Information: | |
Form Length | 11" |
Form Width | 8.50" |
Number of Parts | 1 |
Printed Side | Front |
Print Color | Red |
Physical Characteristics: | |
Product Color | White |
Miscellaneous: | |
Recycled | No |
Country of Origin | United States |
Environmental Certification | Sustainable Forestry Initiative (SFI) |
Questions and Answers
Questions and Answers | Ask CompSource |
Shipping / Returns
Shipping
Ground =
44
(EST. Arrival Date between
Thu.Oct.3 - Tue.Oct.8)
Two Day Air = 114
(EST. Arrival Date on Thu.Oct.3)
Standard One Day = 167
(EST. Arrival Date on Wed.Oct.2 after 3PM)
Priority = 187
(EST. arrival Date on Wed.Oct.2 in the AM)
U.S Mail Priority (AA,AE,AP only) = 113.33
FedEx International Economy (Canada only) = 174
Shipping dates are best estimates based on product location and may vary with holidays.
If product requires trucking, additional fees may apply.
* Some destinations are subject to Applicable State/Duty Taxes
Returns
CompSource realizes that every product may have different return guidelines. Please see the policy below regarding this item.
This Product Has Limited Exchange Privileges.
Limited returns within 30 days of purchase permitted on this product.
For support on this product, please contact Tops. 800-621-1291 www.tops-products.com
Tops Company's Information
Click Tops for all products
Toll Free #: 800-621-1291
Site: www.tops-products.com
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This was my first time dealing with CompSource and I have nothing but good things to say. JORDAN WENT ABOVE AND BEYOND to get my order details sorted out and kept me up to date during the entire process. Customer service was amazing, and what you want out of a great company. I am so pleased with my experience. Keep up the great work! Greg MMore Reviews