[Your company slogan]	Statement
Date: [Enter a date] Statement #[100]
Comments	Bill To	[Name] [Company Name] [Street Address] [City, ST ZIP Code] [Phone] Customer ID [ABC123]
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 [Your Company Name] Thank you for your business! [Your Company Name] [Street Address],[City, ST ZIP Code] Phone [000-000-0000] Fax [000-000-0000] [e-mail]