Health Insurance Claim Forms

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Product Code	Name	Unit QTY	Price	Desired QTY	Total
Claims Forms
CMS1	CMS-1500 1 Part Cont. Feed (08/05)	2500	67.10		$0.00
CMS2	CMS-1500 2 Part Cont. (08/05)	1000	68.20		$0.00
CMS3	CMS-1500 3 Part Cont. (08/05)	1000	97.90		$0.00
CMSLC	CMS-1500 Laser Style (08/05)	2500	74.80		$0.00
UB04LC	UB-04 Hospital Laser Style	2500	74.80		$0.00
UB041	UB-04 Hosp. Claim 1-Pt Cont.	2500	67.10		$0.00
UB042	UB-04 Hosp. Claim 2-Pt Cont.	1000	68.20		$0.00
UB043	UB-04 Hosp. Claim 3-Pt Cont.	1000	97.90		$0.00
UB044	UB-04 Hosp. Claim 4-Pt Cont.	500	69.30		$0.00
UB045	UB-04 Hosp. Claim 5-Pt Cont.	500	71.50		$0.00
1940	ADA Dent Teal Ink Laser (94)	2500	74.80		$0.00
1941	ADA Dent Teal Ink 1-Pt (94)	2500	67.10		$0.00
1942	ADA Dent Teal Ink 2-Pt (94)	1000	68.20		$0.00
2000	ADA Dent Black Ink Laser (2000)	2500	74.80		$0.00
2001	ADA Dent Black Ink 1-Pt (2000)	2500	67.10		$0.00
2002	ADA Dent Black Ink 2-Pt (2000)	1000	68.20		$0.00
2300	ADA Dent Black Ink Laser (2002)	2500	74.80		$0.00
2301	ADA Dent Black Ink 1-Pt (2002)	2500	67.10		$0.00
2302	ADA Dent Black Ink 2-Pt (2002)	1000	68.20		$0.00
2400	ADA Dent Black Ink Laser (2004)	2500	74.80		$0.00
2401	ADA Dent Black Ink 1-Pt (2004)	2500	67.10		$0.00
2402	ADA Dent Black Ink 2-Pt (2004)	1000	68.20		$0.00
2600	ADA Dent Black Ink Laser (2006)	2500	74.80		$0.00
2601	ADA Dent Black Ink 1 pt. Cont. (2006)	2500	67.10		$0.00
2602	ADA Dent Black Ink 2 pt. Cont. (2006)	1000	68.20		$0.00
1500 E	CMS-1500 #10 Window Envelopes	500	48.40		$0.00
1500LR	CMS-1500 9 x 12 1/2 Right Window (self seal)	500	103.40		$0.00
1500LL	CMS-1500 9 x 12 1/2 Left Window (self seal)	500	103.40		$0.00
1500RS	SAME AS 1500LR W/O WORDING	500	103.40		$0.00
					$0.00

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