Statement	Date: [Enter a Date] Statement # [100]
[Your Company Name] [Street Address] [City, ST ZIP Code] [Phone] Fax [000.000.0000] [e-mail]	Bill To	[Name] [Company Name] [Street Address] [City, ST ZIP Code] [Phone] Customer ID [ABC12345]
Comments
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
[Your company slogan]	Make all checks payable to [Your Company Name] Thank you for your business!