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TOPS Centers

for Medicare & Medicaid Services Forms, 2-Part, 8-1/2"W x 11"H, 1500 Forms

Item #: TOP50124RV
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$108.87/CT
Retail Price:
$197.22
You Save:
45%
Item Weight:
31 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: TOP50124R, 50124R
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Specifications
Form Size:
8 1/2 x 11
Forms Per Page:
1
Form Quantity:
1500
Principal Heading(s):
1500 Health Insurance Claim Form
Layout:
One Form per Sheet
Copy Types:
Carbonless Duplicate
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%
Footnote 1:
Carbonless Duplicate
Special Features:
Carbonless Duplicate
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