Remittance Voucher Layout

Date: ___________________________
Voucher Number: ______________

Remittance Details

Payee Information:

• Payee Name: _____________________________________

• Address: _________________________________________

• City, State, ZIP Code: ____________________________

• Email: ____________________________________________

Payment Information:

• Invoice Number: _________________________________

• Payment Amount: $______________________________

• Payment Method:

• Check

• Wire Transfer

• ACH Transfer

• Credit Card

Transaction Date: _____________
Due Date: _____________________

Description of Goods/Services Provided

Subtotal: $______________________________
Tax (if applicable): $____________________
Total Payment Due: $___________________

Authorization

Prepared By:

• Name: [YOUR NAME]

• Title: ______________________

• Signature: ________________

• Date: ______________________

Approved By:

• Name: _____________________

• Title: ______________________

• Signature: _________________

• Date: ______________________

Notes

• Please retain this voucher for your records.

• Ensure all fields are filled out completely to avoid processing delays.

• If payment is made via check, please allow 5-7 business days for processing.

Voucher Templates @ Template.net