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TOPS® UB-04 Forms, 1 Part, White, 8 1/2" x 11", Box Of 2,500 - TOPS BUSINESS FORMS, 59870R TOPS BUSINESS FORMS 59870R UPC   025932598708 TOPS® UB-04 Forms, 1 Part, White, 8 1/2" x 11", Box Of 2,500 UB-04 claim forms used by hospitals file a claim with the patient's insurance company, replaces the UB-92 form Forms are printed to GPO standards in OCR ink on 20 pound stock bond Laser cut sheets 2,500 sets per carton 8.5 x 11 inch sheet size

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