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 April 25, 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 April 25, 2008 Total $ -