##### CUSTOMER PAYMENTS

CUSTOMER
ADDRESS
TIN

|  |  |  | Order No. | Transaction Date | Due Date | Balance
--- | --- | --- | --- | --- | --- | --- | ---

| TOTAL BALANCE |
--- | --- | ---
| TOTAL SELECTED | 0.00

##### Total Amount Due

#

CASH |
--- | ---

CHANGE | 0.00
--- | ---

##### Total Amount Due

#

Bank:

Check Number:
Check Date:
Amount:

CHANGE | 0.00
--- | ---

##### SCAN LOYALTY CARD

##### Total Amount Due

#

CASH |
--- | ---
CARD |
CHECK |
LOYALTY POINTS |
CREDIT SALE |
GIFT CERT/VOUCHER |
OTHERS |

CHANGE | 0.00
--- | ---

##### PAY BY CARD

Bank:
Card Type:

Name on Card:
Card Number (LAST 4 DIGITS):
Reference:
Amount:

##### PAY BY CHECK

Bank:

Check Number:
Check Date:
Amount:

##### PAY BY CREDIT SALES

CHARGED TO ACCOUNT:
Payment Terms:
Due Date:
Amount:

##### PAY BY LOYALTY POINTS

SCAN CARD:
TOTAL AVAILABLE POINTS:
Redeem Points:

##### PAY BY VOUCHER / GIFT CERTIFICATES

Control Number:
Amounts:

##### OTHER PAYMENTS METHODS

Payment Method:
Reference:
Amount: