Create Your Receipt For a Single TransactionCreate a custom receipt for Multiple Transactions Who is being Paid? Name of the Company or Individual Add Contact Information: (optional) Add Contact Information: (optional) Mailing AddressPhone NumberFax NumberE-MailWebsite Mailing Address Street Address Address Line 2 City Please SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington DCWest VirginiaWisconsinWyoming State ZIP Code Phone Number (include area code) Fax Number E-Mail Website URL Client / Customer Who made the Payment? Name of the Customer or Client. Product or Services What was the Payment for? Receipt Breakdown Total Amount Paid $ Would you like to give a Breakdown? Would you like to give a Breakdown? YesNo Such as the Subtotal, Shipping, Taxes, Discount, Amount Paid (previously), and the Remaining Balance. What would you like to include? What would you like to include? SubtotalDiscountShippingTax (sales, VAT, etc.)Total Amount DueRemaining Balance After Payment (if any) Check all that apply Subtotal Amount $ Discount Amount $ As a Dollar Amount ($) and NOT as a percentage (%). Shipping Amount $ Enter Tax $ Total Amount Due $ Remaining Balance after Payment $ Receipt will include Fields for: Receipt will include Fields for: SubtotalDiscountShippingTax (sales tax, VAT, etc.)Total Amount DueRemaining Balance (after payment) Simply uncheck any undesired Fields to remove. Receipt Date Date of this Receipt ESIGN Do you want to Electronically Sign this Receipt? Do you want to Electronically Sign this Receipt? YesNo Sign Here Clear Please draw your signature. Print Name Next Save Save and finish later
