Separate before paying in

# Receipt

## Account / Payable to

CH44 3199 9123 0008 8901 2
Thomas LeClaire
Rue examplaire 22a
1000 Lausanne

## Reference

12 34567 89012 34567 89012 34567

## Payable by (name/address)

## Currency

CHF

## Amount

25.90

## Acceptance point

# Payment part

## Currency

CHF

## Amount

25.90

## Account / Payable to

CH44 3199 9123 0008 8901 2
Thomas LeClaire
Rue examplaire 22a
1000 Lausanne

## Reference

12 34567 89012 34567 89012 34567

## Additional information

Invoice 1234568
Gardening work
Bill Information

## Payable by (name/address)