Collection account 001

NAME OF THE COMPANY TO BE

COLLECTED
Nit. 888.000.999-7

DUE TO:

NAME OF THE PERSON WHO PAYS

DC 1,111,111,111 of the City (Department).

THE SUM OF:

Two hundred thirty thousand pesos ($230,000,oo)

For the concept of:

- Something.
- Another thing.

Cordially,

Name of the person who collects

DC 1,111,111,111
Telephone 123-1234567
Address Street X # 0-00
*Bank account to deposit the money.