Adams® Health Insurance Claim Form, 2-Part, 8 1/2" x 11", 100 Sets
| Country | USA |
| Brand | Citizen |
| Manufacturer | Citizen Watch Company |
| Binding | Watch |
| ItemPartNumber | EM1052-51A |
| Model | EM1052-51A |
| Color | Gold Tone |
| ReleaseDate | 2023-01-01 |
| Size | 5 Inches |
| UPCs | 013205157547 |
| EANs | 0013205157547 |