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Tops UB-04 Continuous Billing Form

Computer Supplies Sale

Description:

www.tops-products.com

UB-04 continuous form is designed for hospitals to file a claim with the patient's insurance company. Forms are printed to Government Printing Office standards in OCR ink on 20 lb bond.

Medicare and Medicaid Services

Claim Form 59772R Tops UB-04 Continuous Billing Form White Tops 19 lb Perforated US No 0% 0% No 11" Length x 9.5" Width 2 Part Carbonless Front Side Form With Black Ink 1000 / Carton Laser

New from $101.99

Tops UB-04 Continuous Billing Form

$101.99






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HP No. 45 Black Ink Cartridge ($32.99)
www.hp.com

Pigment-based ink cartridge provides denser, more waterfast, fade-resistant printouts. Professional-quality printouts every time. Designed for use with Hewlett-Packard Color Copier 110, 120, 140, 145, 150, 155, 160, 260, 270, 180, 190, 280, 290; Deskjet 750C, 750C+, 755CM, 710C, 720C, 722C, 820CSE/CXI, 830C, 832C, 850C, 855CSE, 855CXI, 870CSE, 870CXI, 880C, 882C, 890CM, 890CXI, 895CSE, 895CXI, 930C, 932C, 935C, 950C, 952C, 960C/CSE/CXI, 970CSE, 990CM/CSE/CXI, 995C/CK, 1000CSE, 1000CXI, 1100C, 1120 Series, 1200CSE, 1220CXI, 1600 Series, 6122, 6127, 9300, FAX 1220/XI; Officejet G55, G85, G95, K60, K80, R40, R45, R60, R65, R80, T45, T65; Officejet Pro 1150C, 1150CSE, 1170CSE/CXI, 1175CSE/CXI; Photosmart P1000, P1100, 1115, 1215, 1218 and 1315 Series. Yields 830 pages.

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