TOPS CMS-1500 Health Insurance Claim Forms, 2-Part Carbonless, Continuous, 9.5 x 11 Inches, 1500 Sheets per Carton (50124RV)
</br></br>
<div style="text-align:left">
<b>[Product Information]</b><br>
<ul>
<li>CMS-1500 health insurance claim form</li>
<li>Printed in OCR red ink for scanning</li>
<li>Approved by CMS, NUCC and OMB</li>
<li>2-part continuous</li>
<li>Made in the USA</li>
</ul>
</div>
</br></br></br></br></br></br></br></br></br></br>

</br></br></br></br></br></br></br></br></br></br>
<img src='http://ecx.images-amazon.com/images/I/51hMEXirWoL.jpg'></br>