TOPS® Continuous UB-04 Forms, 1-part, White, 9 1/2" x 11", Box Of 2500

Item # 524950

$190.09 / carton


  • ✓ Free delivery
  • Est. Delivery 1-3 business days
  • ✓ In Stock
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Reg. Price $190.09
Checkout Price $190.09
Your Price $190.09
  • Description
    • Each form meets the requirements of the Centers for Medicare and Medicaid Services (CMS).
    • Printed in OCR black ink on perforated, carbonless, 20-lb paper to ensure better scanning and reproduction.
    • Available in laser or continuous formats.
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