Customer Statement

Customer Statement From: Address: Phone: To: Address: Phone: Statement Date: Invoice Date Invoice # Statement # Customer # Description Page # Amount Shippers Reference # Statement Total: Please return with your remittance Customer Name: Address: Phone: Statement Date: Customer Number: Amount Remitted: Statement Number: Statement Total: American LegalNet, Inc. www.FormsWorkFlow.com 2001 © American LegalNet, Inc. Customer Statement From: Address: Phone: To: Address: Phone: Statement Date: Statement # Customer # Page # Reference Date Code Description Amount Balance P = Payment Codes: C = Credit Memo I = Invoice D = Debit Memo A= Discount Allowed F = Finance Charge Total Due Please return with your remittance Customer Name: Address: Phone: Statement Customer Number: Amount Remitted Statement Number: Statement Total: American LegalNet, Inc. www.FormsWorkFlow.com 2001 © American LegalNet, Inc.