Your Company Name
Street Address Address 2 City, ST ZIP Code Phone: Fax: E-mail: (413) 555-0190 (413) 555-0191 someone@example.com
Statement
Statement #: Date: Customer ID: Enter statement number August 12, 2008 Enter customer ID Bill To: Name Company Name Street Address Address 2 City, ST ZIP Code Payment Balance
Date
Type
Invoice #
Description
Amount
Reminder: Please include the statement number on your check. Terms: Balance due in 30 days. REMITTANCE Customer Name: Customer ID: Statement #: Date: Amount Due: Amount Enclosed: Enter customer name Enter customer ID Enter statement number August 12, 2008
Total
$
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