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UB04 CLAIM FORMS (New UB04 form replaces UB92 form)
AVAILABLE IN EITHER LASER-CUT SHEETS OR ONE OR TWO-PART CONTINUOUS (TRACTOR-FEED) FORMS ON HIGH-QUALITY PAPER TO GOVERNMENT STANDARDS.

We still have the Old Version UB-92 forms available in our On-Line Store CLICK HERE

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TO ORDER BY PHONE
CONTACT US
TOLL FREE AT:
1-877-840-1500
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8-12 noon Fri CST

Description
UB04 CLAIM FORMS
(Replaces UB92)

Qty./
Case

Price/
Case

CLICK HERE TO

LASER Version
Laser, Ink Jet, Bubble Jet Printer Compatible

500

$19.99

LASER Version
Laser, Ink Jet, Bubble Jet Printer Compatible

2500

$35.00

1 Part Continuous

2500

$35.00

2 Part Continuous

1000

$42.95

ALL OUR FORMS ARE OF THE HIGHEST QUALITY,  ARE PRINTED IN STRICT COMPLIANCE  WITH GOVERNMENT SPECIFICATIONS AND ARE APPROVED BY MEDICARE, THE HEALTH CARE FINANCE ADMINISTRATION AND THE INSURANCE INDUSTRY.

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