Платежное поручение

Поступ.в банк плат.

                                             ____________    ________________
               ПЛАТЕЖНОЕ ПОРУЧЕНИЕ  N        :           :   :               :
                  _________ 199__г.          :           :   :    0401002    :
                                             :___________:   :_______________:

Плательщик                                       ДЕБЕТ            Сумма
 ____________                                 _______________________________
:            :                                :            :                 :
:   Код      :                                :            :                 :
:____________:________________________________:            :                 :
                                   :          :            :                 :
Банк плательщика        в г.       :   Код    : Сч. N      :                 :
__________________________________ :__________:____________:                 :
Получатель                                                 :                 :
                                                 КРЕДИТ    :                 :
                                               ____________:_________________:
_____________                                  :           :                 :
:            :                                 :Сч. N      :                 :
:   Код      :                                 :           :                 :
:____________:________________________________ :___________:_________________:
                                   :           :           :                 :
Банк получателя         в г.       :   Код     :Сч. N      :                 :
___________________________________:___________:__________ :_________________:
          почтой - телеграфом (нужное подчеркнуть)         :                 :
                                                           :пеня за ___дней  :
                                                           :из ____ % Р.     :
                                                           :                 :
                                                           :_________________:
                                                           :                 :
                                                           :                 :
                                                           :                 :
Сумма прописью                                             : сумма с пеней   :
___________________________________________________________:_________________:
                                                           :         :       :
Дата получения товара, оказания услуг  __________19__г.    :Вмд опер.:       :
___________________________________________________________:_________:_______:
                                                           :         :       :
Назначение платежа, наименование товара, выполненных       :Назн.плат:       :
работ, оказанных услуг, NN и суммы товарных документов     :_________:_______:
                                                           :         :       :
 Дата отгрузки         19___г.:  Способ отправл.кв./накл.N :Срок.плат:       :
______________________________:____________________________:_________:_______:
                                                           :         :       :
                                                           :Очер.плат:       :
                                                           :_________:_______:
                                                           :         :       :
                                                           :гр.банка :       :
                                                           :_________:_______:

_____________________
:                    :                            :  Проведено банком
:                    :                            :  "___"__________ 199__г.
:                    :                            :
:     М.П.           :                            :  подписи банка
:                    :                            :
:____________________:                            :
                                                  :
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