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1 Part Laser Printer UB04 (HCFA 1450) Form. 100 minimum quantity. Ships in 24 hours.
NEW UB04 (HCFA 1450) forms for laser printers.
Also works in inkjet printers.
1 part OCR scanable paper.
Red ink.
100% compatible with UCCI requirements.
This is the NEW UB04 (HCFA 1450) form mandated in 2007, adding the split provider identifier fields for NPI numbers.
Minmum order is 100 laser compatiible UB04 forms.
24 hour turnaround.
Expedited shipping available.
100 forms per pack.
Minimum order is 100 UB04 (HCFA 1450) forms.
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