Company _____________________________

adress: _______________________________
State: Romania, Country: Mures

STATEMENT OF OPEN ITEMS

On ______________

Costumer name: ________________________________

Costumer adress: _______________________________
Location: _____________________________________

Account Date Doc. No. Debit Demand

TOTAL :

Your Account shows a balance of ____________ EUR in OUR favor.

Please match your state with ours and return one copy from it.
If in period of 20 days we don’t recive any statement or deny of this document, we would
consider it matched.
(stamp and signature of issuer)

CONFIRMING THE OPEN ITEMS

--------------------------------------------------------------------------
(stamp and signature of cotumer)

--------------------------------------------------------------------------
(Location and date)

We deny the shown state in TOTAL/PARTIAL for the amount of _________ EUR,
because of the follwing reasons:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________