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To order by phone call toll free: 1-877-840-1500

UB04 & CMS-1500 / HCFA-1500
CLAIM FORM ENVELOPES
ALL ENVELOPES FOR CMS 1500 FORMS ARE SELF-SEAL.
ALL ENVELOPES HAVE SECURITY LINER.

IMPRINT YOUR RETURN ADDRESS
Your return address can be imprinted in the upper left of all envelopes.
Call for imprinting details.
1-877-840-1500

Description

Picture of Envelope

Quantity/Case

Price/Case

Secure Order

Envelopes for
CMS/HCFA 1500
#10 (9-1/2" x 4-1/8")
Right Window

ITEM # D38

 

500

$29.20


Quantity:
 

NEW!
Printed
Envelopes for
CMS/HCFA 1500
#10 (9-1/2" x 4-1/8")
Right Window

ITEM # DI38

 

500

$48.00


Quantity:
 

Envelopes for
CMS/HCFA 1500
9"x12.5"
Right Window

ITEM # D36
 

Click for Enlarged Image
of this Envelope

 

500

$95.00


Quantity:
 

Envelopes for
UB04
#10 (9-1/2" x 4-1/8")
Left Window

ITEM # DUBENV10
NOT SELF-SEAL

 

500

$29.20


Quantity:
 

Envelopes for
UB04
9"x12.5"
Left Window

ITEM # DUB04CAT
 

Click for Enlarged Image
of this Envelope

 

500

$95.00


Quantity:
 

NEW!
Envelopes for
UB04
9"x 5-13/16"
Left Window

ITEM # DUBENVMED

Simply fold the UB04
in half and insert!
The envelope has an inside tint for HIPAA compliance and moistenable gum flap.

 

500

$72.00


Quantity:
 

We can imprint your company return address on all envelopes. Call for information. 1-877-840-1500

Discounts available for large quantities.
Contract pricing available. Call for details!

ALL OUR FORMS ARE OF THE HIGHEST QUALITY, ARE PRINTED IN STRICT COMPLIANCE WITH GOVERNMENT SPECIFICATIONS AND ARE APPROVED BY CENTERS FOR MEDICARE AND MEDICAID SERVICES AND THE INSURANCE INDUSTRY.
OUR FORMS HAVE BEEN APPROVED BY THE GOVERNMENT.
The American HCFA Forms division of DFL Enterprises, Inc. is an independent supplier of US Government
approved claim forms and NOT an affiliate of CMS (
www.cms.gov)

WE ACCEPT VISA, MASTERCARD and AMERICAN EXPRESS

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IF YOU HAVE ANY QUESTIONS OR TO ORDER BY PHONE
CONTACT US TOLL FREE AT:
 1-877-840-1500
FAX: 1-985-809-5788
Our Office Hours are:
 Monday - Thursday: 8am - 5pm CST
Friday: 8am - 12 noon CST

EMAIL US

AMERICAN HCFA FORMS is a Division of
124 Pine Oak Dr., Covington, LA 70433
PHONE: 985-875-0800
FAX: 1-985-809-5788

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