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UB04 Claim Forms For Pinfeed Printers

NEW UB04 Forms For Pinfeed Printers
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Name: NEW UB04 Forms For Pinfeed Printers
Your Price:
From $28.75 to 33.75 per carton
Serial Number: L0261



Pinfeed Printer UB04 (HCFA 1450) Forms. 1 carton minimum quantity. Ships in 24 hours.

NEW UB04 (HCFA 1450) forms for pinfeed printers.
OCR scanable paper - 1st copy.
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.
Minimum order is 1 carton pinfeed compatiible UB04 forms.
24 hour turnaround.
Expedited shipping available.

2500 forms per carton-1 part forms
1000 forms per carton-2 part forms
500 forms per carton-3 part forms
Minimum order is 1 carton of UB04 (HCFA 1450) forms.

Number of Parts::
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Bulk Pricing:
Min Qty Price Per Unit
1 $33.75
3 $31.75
7 $29.75
10 $28.75
Quantity To Order:
   

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