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Cash Business Name Here Business Address City, State and Zip Code Phone, Fax Website: www.websiteaddress.com Date: _____________________ Receipt Num: xxxxxxxxxxxxxx Amount Received From: _________________________________________________________ Address: ________________________________________________________________ ______ ________________________________________________________________ Account Total Amount Due Amount Paid Payment Made BY Cash Cheque Others Amount Received By: ___________________________________________________________ ____________________ _____ ____________________ _____ Cash Business Name Here Business Address City, State and Zip Code Phone, Fax Website: www.websiteaddress.com Date: _____________________ Receipt Num: xxxxxxxxxxxxxx Amount Received From: _________________________________________________________ Address: ________________________________________________________________ ______ ________________________________________________________________ Account Total Amount Due Amount Paid Payment Made BY Cash Cheque Others Amount Received By: ___________________________________________________________ ____________________ _____ ____________________ _____

Payment Receipt Template

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Page 1: Payment Receipt Template

Cash ReceiptBusiness N

ame H

ereBusiness Address

City, State and Zip CodePhone, Fax

Website: w

ww

.websiteaddress.com

Date: _____________________ Receipt Num: xxxxxxxxxxxxxx

Amount Received From: _________________________________________________________

Address: ______________________________________________________________________ _____________________________________________________________________________

Amount: ______________________________________________________________________

Purpose of Payment: ____________________________________________________________ ______________________________________________________________________________

AccountTotal Amount DueAmount PaidBalance Due

Payment Made BYCashChequeOthers

Amount Received By: ___________________________________________________________

_________________________Authorized Signatures

_________________________Authorized Signatures

Cash Receipt

Business Nam

e Here

Business AddressCity, State and Zip Code

Phone, FaxW

ebsite: ww

w.w

ebsiteaddress.com

Date: _____________________ Receipt Num: xxxxxxxxxxxxxx

Amount Received From: _________________________________________________________

Address: ______________________________________________________________________ _____________________________________________________________________________

Amount: ______________________________________________________________________

Purpose of Payment: ____________________________________________________________ ______________________________________________________________________________

AccountTotal Amount DueAmount PaidBalance Due

Payment Made BYCashChequeOthers

Amount Received By: ___________________________________________________________

_________________________Authorized Signatures

_________________________Authorized Signatures

410041 Central RI Bordereau Payment&Receipt 03a

410041 Central RI Bordereau Payment&Receipt 03a

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