Sample Statement of Account

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The Pi Kappa Alpha Fraternity Statement For: Please Pay By: Amount Due:

<Chapter Name> <Month> <Year> <Due Date> <Amount Due>


<Host Institution>
<Chapter Address>
<City>, <State> <Zip Code> Please make checks payable to:
<Chapter Name> of The Pi Kappa Alpha Fraternity
<Chapter Phone #>
<Chapter Website>
Questions? Contact:
<Member Name>
<c/o Name> <Treasurer Name>, Chapter Treasurer
<Member Address> Phone: <Treasurer Phone #>
<City>, <State> <Zip Code> E-mail: <Treasurer E-mail>

Statement of Account

Date Description Amount


Previous Balance $ -
Payment(s) Received
<Payment Desciption> -
Opening Balance $ -
Interest on Unpaid Balance (12% annual) -
Member Dues

International Fraternity Chapter Assessment


Liability Protection Program Assessment
Interfraternity Council Assessment
Pike University Leadership Conference Reserve
Composite Assessment
Programming Assessment
Meal Plan
Room Rental
Parlor Fee

Balance $ -

Opening Balance New Charges New Balance


<Opening Balance> <New Charges> <Amount Due>

Thank you for your prompt payment!

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