Remittance Voucher Layout
Remittance Voucher Layout
Date: ___________________________
Voucher Number: ______________
Remittance Details
Payee Information:
-
Payee Name: _____________________________________
-
Address: _________________________________________
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City, State, ZIP Code: ____________________________
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Email: ____________________________________________
Payment Information:
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Invoice Number: _________________________________
-
Payment Amount: $______________________________
-
Payment Method:
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Check
-
Wire Transfer
-
ACH Transfer
-
Credit Card
Transaction Date: _____________
Due Date: _____________________
Description of Goods/Services Provided
|
Description |
Quantity |
Unit Price |
Total |
|---|---|---|---|
|
________________________________ |
________ |
$_________ |
$_________ |
|
________________________________ |
________ |
$_________ |
$_________ |
|
________________________________ |
________ |
$_________ |
$_________ |
Subtotal: $______________________________
Tax (if applicable): $____________________
Total Payment Due: $___________________
Authorization
Prepared By:
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Name: [YOUR NAME]
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Title: ______________________
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Signature: ________________
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Date: ______________________
Approved By:
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Name: _____________________
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Title: ______________________
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Signature: _________________
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Date: ______________________
Notes
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Please retain this voucher for your records.
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Ensure all fields are filled out completely to avoid processing delays.
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If payment is made via check, please allow 5-7 business days for processing.
