Statement
[Company Slogan]	Date: [Click to select date] Statement # [No.]
Comments	Bill To	[Customer Name] [Company Name] [Street Address] [City, ST ZIP Code] [phone] Customer ID [No.]

Date	Description	Balance	Amount
Current	1-30 Days Past Due	31-60 Days Past Due	61-90 Days Past Due	Over 90 Days Past Due	Amount Due

Remittance
Statement #	100
Date
Amount Due
Amount Enclosed

Make all checks payable to [Company Name]

Thank you for your business!

[Company Name] [Street Address, City, ST ZIP Code] [phone] [fax] [email]