UB04 Insurance Claim Form, 1-Part Continuous White, 9 1/2...
$159.99
Required by Centers for Medicaid and Medicare Services (CMS) and by most private healthcare organizations, these forms speed up claims processing...
Purchase Order Book, Bottom Punch, 5 1/2 x 7 7/8, Two-Part Carbonless, 50 Forms
$7.59
Tax excluded
Keep a bound copy for a permanent record. Stop card prevents write-through to other form sets. Consecutively numbered in red.
RED1L140
2451 Items
Data sheet
- Special Features
- Carbonless Duplicate
- Punching
- Bottom, Two-Hole
- Punching
- Hanging Hole
- Binding
- Top
- Binding
- Stapled
- Paper Color(s)
- Blue
- Paper Color(s)
- White
- Global Product Type
- Forms-Sales & Work Order
- Cover Material(s)
- Flexible
- Pre-Consumer Recycled Content Percent
- 0%
- Post-Consumer Recycled Content Percent
- 0%
- Total Recycled Content Percent
- 0%
- Form Size
- 5 1/2 x 7 7/8
- Forms Per Page
- 1
- Number of Entry Lines
- 12
- Form Quantity
- 50
- Principal Heading(s)
- Purchase Order
- Layout
- One Form on Page
- Print and Ruling Color(s)
- Blue
- Numbering
- Preprinted Listing Lines
- Numbering
- Preprinted at Top
- Numbering Color(s)
- Red
- Numbering Color(s)
- Blue
- Copy Types
- Carbonless Duplicate
- Copy Paper Color(s)
- Yellow
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Keep a bound copy for a permanent record. Stop card prevents write-through to other form sets. Consecutively numbered in red.