Finance & banking
Payment voucher template (US)
A general template under US law. Laws differ from state to state, so check it against your state's law or with a lawyer licensed there. We are not a law firm and do not give legal advice.
Fill in this template- Written for US law, with your state left to fill in
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Preview — US standard
Payment Voucher
Company Name
Company Address
Voucher no.: Voucher Number
Date: Voucher Date
| Item | Details |
| --- | --- |
| Paid to | Payee Name |
| Payee address | Payee Address |
| Amount | $Amount |
| Amount in words | Amount in Words dollars |
| Payment method | Check Number, ACH, Wire or Cash |
| For | Purpose of Payment |
| Invoice or reference | Invoice or Reference Number |
| Expense account or cost center | Account Code |
| Form W-9 on file (for vendors who may need a Form 1099) | Yes or No |
Supporting documents attached: Supporting Documents
Approvals
| Role | Name | Signature | Date |
| --- | --- | --- | --- |
| Prepared by | Preparer Name | Preparer Signature | Preparer Date |
| Approved by | Approver Name | Approver Signature | Approver Date |
| Paid by | Payer Name | Payer Signature | Payment Date |
Received
Received the amount above in full.
Payee signature: Payee Signature Date: Receipt Date