Платежное требование

Поступ.в банк плат.

                                             ____________    ________________
               ПЛАТЕЖНОЕ ТРЕБОВАНИЕ N        :           :   :               :
                  _________ 199__г.          :           :   :    0401001    :
                                             :___________:   :_______________:

Плательщик                                       ДЕБЕТ            Сумма
 ____________                                 _______________________________
:            :                                :            :                 :
:   Код      :                                :            :                 :
:____________:________________________________:            :                 :
                                   :          :            :                 :
Банк плательщика        в г.       :   Код    : Сч. N      :                 :
__________________________________ :__________:____________:                 :
Получатель                                                 :                 :
                                                 КРЕДИТ    :                 :
                                               ____________:_________________:
_____________                                  :           :                 :
:            :                                 :    Сч. N  :                 :
:   Код      :                                 :           :                 :
:____________:________________________________ :___________:_________________:
                                   :           :           :                 :
Банк получателя         в г.       :   Код     :Сч. N      :                 :
___________________________________:___________:__________ :_________________:
                                                           :                 :
_____________                                              :пеня за ___дней  :
:            :                                             :из ____ % Р.     :
:   Код      :       Грузотправитель и ст.отпр.            :                 :
:____________:_____________________________________________:_________________:
                                                           :                 :
_____________                                              :                 :
:            :                                             :                 :
:   Код      :       Грузополучатель и ст.назнач.          : сумма с пеней   :
:____________:_____________________________________________:_________________:
                              :                            :         :       :
 Договор                      :                            :Вмд обр. :       :
_________                     :                            :_________:_______:
                              :                            :         :       :
 Заказ N                      :                            :Вид опер.:       :
                              :                            :_________:_______:
______________________________:                            :         :       :
 Дата отгрузки         19___г.:  Способ отправл.кв./накл.N :Очер.плат:       :
______________________________:____________________________:_________:_______:
                                                           :         :       :
Наименование товара, выполненных работ, оказанных услуг,   :Назн.плат:       :
NN и суммы товарных документов или спецификация товаров.   :_________:_______:
                                                           :         :       :
                                                           :Срок плат:       :
                                                           :_________:_______:

                                                  :  Проведено банком
                                                  :  "___"__________ 199__г.
                                                  :
                                                  :  подписи банка
                                                  :
            ______________________________________:
                                                  :
  М.П.      Предусмотренные договором документы   :
            отосланы (вручены) плательщику        :
            "___"__________19___г.                :

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