ContractRemittance Agreement • November 5th, 2013
Contract Type FiledNovember 5th, 2013Example 1 Company Remittance Section Address Agreement Number: 123-1234567-000 City, State Zip Invoice Number: 87654321 Invoice Date: MM/DD/YY Invoice Due Date: MM/DD/YY Return Service Requested Total Current Due: 500.00 Total Past Due: 0.00 Check here for change of address (see reverse for details) Total Due: $500.00 Use enclosed envelope and make check payable to: CUSTOMER Company ADDRESS Address CITY, ST ZIP City, ST Zip