[BILLING STATEMENT] COMPANY NAME STREET ADDRESS CITY, STATE, ZIP PHONE Charges and payments received after statement closing date will appear on your next month's statement. TO: ACCOUNT NO.: STATEMENT CLOSING DATE: / /======================================================================| DATE | DESCRIPTION | AMOUNT ||-----------|--------------------------------------|-----------------|| | Previous Balance: | ||-----------|--------------------------------------|-----------------||___________|______________________________________|_________________||___________|______________________________________|_________________||___________|______________________________________|_________________||___________|______________________________________|_________________||___________|______________________________________|_________________||___________|______________________________________|_________________||___________|______________________________________|_________________||___________|______________________________________|_________________||___________|______________________________________|_________________||___________|______________________________________|_________________||___________|______________________________________|_________________||___________|______________________________________|_________________||___________|______________________________________|_________________||___________|______________________________________|_________________||___________|______________________________________|_________________||___________|______________________________________|_________________||___________|______________________________________|_________________||___________|______________________________________|_________________| Last amount in this column is your new balance.______________________________________________________________________| CURRENT | 30 DAYS | 60 DAYS | 90 DAYS | 120 DAYS ||-------------|-------------|-------------|-------------|------------||_____________|_____________|_____________|_____________|____________|A $1.00 late fee will be added monthly on accounts 85 days past due.
