8 1/2" x 4" NCR paper, three copies (white, yellow and pink-fits #10 window envelope).

Used as initial rental receipt to establish tickler, then as continuing billing document, for direct billing or debit to account. Form can be magnetically encoded. First copy is statement, second copy is customer receipt and final copy is files in appropriate month for billing subsequent years.

Specify: Name of Financial Organization, Address and Phone, City, State and Zip. (Printed orders must be ordered in quantities of 250). May be purchased without print for $1.00 each.