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Brand

TOPS(3)

 
Recycled

No(3)

 
Height

9.5"(1)

 
Manufacturer Part Number

50126RV(1)

50135RV(1)

59870R(1)

 
Country of Origin

United States(3)

 
Width

11"(1)

 
Sheet Size

11" Width x 8.50" Length(1)

 
Print Color

Red(3)

 
Basis Weight

20 lb(2)

 
Number of Parts

1(2)

 
Form Length

8.50"(1)

11"(1)

 
Form Width

11"(1)

8.50"(1)

 
Printed Side

Front(1)

 
Product Type

Health Insurance Form(2)

Claim Form(1)

 
Packaged Quantity

500 / Pack(1)

250 / Pack(1)

2500 / Carton(1)

 
Product Model

UB-04(1)

 
Sheet Color

White(1)

 
 
 

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