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1 Part Laser Printer UB92 (HCFA 1450) Form. 2500 minimum quantity. Ships in 24 hours.
Old 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 2500 laser compatiible UB04 forms.
24 hour turnaround.
Expedited shipping available.
2500 forms per carton.
Minimum order is 2500 UB04 (HCFA 1450) forms.
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