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UB-04 Forms, 2 Part Continuous
Laser UB-04 Form

UB-04 Forms, 2 Part Continuous

Your Price:$33.50
Part Number:WEB-CCF-UB04-2
Quantity Pricing
Quantity
Price
  • 5 - 9
  • $31.50
  • 10 - 19
  • $30.50
  • 20+
  • $29.50
2 Part Continuous- 9.5 x 11 for pin fed printers
Box quantity: 1000

Printed in red, OCR scannable ink in complaince with government standards
Medicare approved for billing Medicare Part A claims

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