STATEMENT [Your Company Slogan]

Date: June 10, 2017

Statement # [100]

[Your Company Name] BILL TO [Name]

[Street Address] [Company Name]
[City, ST ZIP Code] [Street Address]
[Phone] [City, ST ZIP Code]
Fax [000-000-0000] [Phone]
[E-mail address] Customer ID [ABC12345]

Comments

DATE DESCRIPTION BALANCE AMOUNT

1-30 DAYS 31-60 DAYS 61-90 DAYS OVER 90 DAYS

CURRENT AMOUNT DUE
PAST DUE PAST DUE PAST DUE PAST DUE

REMITTANCE

Statement # 100

Date
Amount Due
Amount Enclosed

Make all checks payable to [Your Company Name]

Thank you for your business!