General Information

Manufacturer: TOPS Products
Manufacturer Part Number: 59770R
Manufacturer Website Address:
Brand Name: TOPS
Product Model: UB-04
Product Name: UB-04 Continuous Forms
Marketing Information: 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.
Packaged Quantity: 2500 / Carton
Product Type: Claim Form

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

Recycled: No
Assembly Required: No
Environmentally Friendly: Yes
Environmental Certification: SFI
Country of Origin: United States