Remittance Voucher Layout
Date: ___________________________
Voucher Number: ______________
Remittance Details
Payee Information:
Payee Name: _____________________________________
Address: _________________________________________
City, State, ZIP Code: ____________________________
Email: ____________________________________________
Payment Information:
Transaction Date: _____________
Due Date: _____________________
Description of Goods/Services Provided
Description | Quantity | Unit Price | Total |
|---|
________________________________ | ________ | $_________ | $_________ |
________________________________ | ________ | $_________ | $_________ |
________________________________ | ________ | $_________ | $_________ |
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
