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TOPS®: CMS Health Insurance Form 1500 Claim, 8-1/2 x 11, 250/Pack, Loose Forms
	Quantity in Basket: None Code: TOP-50135R Price: $14.41
	Quantity:
TOPS® Centers for Medicare and Medicaid Services (CMS) Forms with Sensor Bar Centers for Medicare and Medicaid Services (CMS) claim form with sensor bar. CMS-1500 claim forms (formerly known as HCFA-1500 claim forms) expedite Medicare, Medicaid or private insurance benefits. Top sensor bar for microfiche duplication, as required in some states. OCR red ink for scanning. • UPC = 025932501357 • Weight = 2.59 lbs/PK • Mfgr Code: 50135R • Mfgr Name: TOPS BUSINESS FORMS • PRICED PER PK List Price = $18.40 Our Price = $14.41 Your Savings = $3.99 If your SHIP TO address is in California, you will receive a second invoice showing the California SALES TAX that you paid for this item