TOPS UB-04 Hospital Claim Form - 1 Part - 11" x 8.50" Form Size - Red Print Color - 2500 / Carton 59870R TOP59870R pg.979.
59870R | Tops®
Part Number: 59870R
Catalog Page: 979 all products on page
Unit: CT
Condition: New
In Stock: 10
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Product Specifications
TOPS UB-04 Hospital Claim Form - 1 Part - 11" x 8.50" Form Size - Red Print Color - 2500 / Carton 59870R TOP59870R pg.979.
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: 818237890116
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 | 818237890116 |
| 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) |
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Shipping / Returns
Shipping
Ground =
44
(EST. Arrival Date between
Wed.Nov.20 - Mon.Nov.25)
Two Day Air = 114
(EST. Arrival Date on Wed.Nov.20)
Standard One Day = 167
(EST. Arrival Date on Tue.Nov.19 after 3PM)
Priority = 187
(EST. arrival Date on Tue.Nov.19 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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