.
Item(s): 0
View Cart

Log In

  • Track your delivery information. Track Order
  • Scan order to shopping cart. Scan Order
  • Return an Item. Return Item
  • Request a quote. Request Quote
  • Create a business account. Create Account
HP Ink and Toner Qualified Partner

Refine Results

Current Criteria
Refine by Keyword
Manufacturers
Number of Parts
  • 1 (2)
  • 2 (1)
Form Width
Form Length
Sheet Color
Carbonless Copy
Sheet Size Vertical
Sheet Size Horizontal

Show: Results: 1 - 3 of 3 Price:


TOPS 1-part UB-04 Laser-cut Forms
1 Part - 11" x 8.50" Form Size - Red Print Color - 2500 / Carton
  • Continuous forms are designed for hospitals to file a claim with the patient's insurance company
  • Forms are printed to GPO standards in OCR ink on 20 lb. bond
$202.12 CT
TOP59870R
Qty
TOPS UB-04 Continuous Forms
1 Part - 11" x 9.50" Form Size - Red Print Color - 2500 / Carton
  • UB-04 1-part continuous is a form that hospitals use to file a claim with the patient's insurance company
  • Forms are printed to GPO standards in OCR ink on 20 lb. bond
$178.13 CT
TOP59770R
Qty
TOPS Two-part CMS-1500 Forms
2 Part - Carbonless Copy - 8 1/2" x 11" Sheet Size - White Sheet(s) - Red Print Color - 1500 / Carton
  • Complies with current physicians' standards for expediting Medicare and Medicaid payments
  • Meets requirements of the Centers for Medicare and Medicaid Services
$183.21 CT
TOP50124R
Qty

Enter your Zip/Postal Code

Save Cancel

Note: cookies must be enabled.

Add to Favorites

Category:

Submit Cancel

View favorites / manage categories

This site is intended only for use by residents of The United States of America.
Copyright © Cubie - San Antonio TX. All Rights Reserved.
All trademarks, product names, company names and logos cited herein are the property of their respective owners.