Disbursement Voucher
Disbursement Voucher
[YOUR COMPANY NAME]
|
Bill To: |
Payment Method: |
|
Name: Maria Turner Address: Philadelphia, PA 19102 Email: maria@email.com Phone: 222 555 7777 |
Payment Type: Credit Card Card Number: 12 3456 7890 1234 Expiry Date: 12/64 |
Items
|
Item |
Description |
Quantity |
Unit Price |
Total |
|---|---|---|---|---|
|
Item 1 |
Widget A - Basic Model |
2 |
$50.00 |
$100.00 |
|
Item 2 |
Widget B - Premium Model |
1 |
$75.00 |
$75.00 |
|
Item 3 |
Widget C - Compact Version |
3 |
$20.00 |
$60.00 |
Summary
-
Subtotal: $235.00
-
Tax (10%): $23.50
-
Total: $258.50
Signature: _______________________
Date: 01/12/2060
