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Made in the USA

TOPS Centers

for Medicare & Medicaid Services Forms, 8-1/2"W x 11"H, 3000 Forms

Item #: TOP50122RV
Buy 11+ for Free Shipping!
$94.84/CT
Retail Price:
$189.86
You Save:
50%
Item Weight:
32 LBS / CT
In Stock!
Description: Expedite Medicare, Medicaid or private insurance benefits. NUCC, CMS and AMA approved format. (02/12) version. Printed front and back in red OCR ink for scanning.
Part Numbers: TOP50122R, 50122R
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Specifications
Form Size:
8 1/2 x 11
Forms Per Page:
1
Form Quantity:
3000
Principal Heading(s):
1500 Health Insurance Claim Form
Layout:
One Form per Sheet
Punching:
Dot Matrix Holes
Printer Compatibility:
Dot Matrix
Paper Stock:
20-lb.
Paper Color(s):
White
Print and Ruling Color(s):
OCR Red
Pre-Consumer Recycled Content Percent:
0%
Post-Consumer Recycled Content Percent:
0%
Total Recycled Content Percent:
0%
Special Features:
Continuous Form
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