                       [BILLING STATEMENT]



                            COMPANY NAME
                           STREET ADDRESS
                          CITY, STATE, ZIP
                               PHONE


Charges and payments received
after statement closing date
will appear on your next
month's statement.
     TO:






     ACCOUNT NO.:                  STATEMENT CLOSING DATE:  /  /
======================================================================
|  DATE     |     DESCRIPTION                      |  AMOUNT         |
|                                Previous Balance: |                 |
|           |                                      |                 |
|           |                                      |                 |
|           |                                      |                 |
|           |                                      |                 |
|           |                                      |                 |
|           |                                      |                 |
|           |                                      |                 |
|           |                                      |                 |
|           |                                      |                 |
|           |                                      |                 |
|           |                                      |                 |
|           |                                      |                 |
|           |                                      |                 |
Last amount in this
column is your new
balance.
______________________________________________________________________
|  CURRENT    |  30   DAYS  |  60   DAYS  |  90   DAYS  | 120   DAYS |
|             |             |             |             |            |
A $1.00 late fee will be added monthly on accounts 85 days past due.












