Metrobank PAYMENT SLIP

Paymen Forndlyfilkoutsearate sio for each modeof payment) CASH DENOMINATION BREAKDOWN
PESO BLUNG DOLLARBILLING DATEA DENOMINATION PIECES AMOUN
AN TYFE VICEF 1000
VERS A 500
8sCREER CARD-O NNAAME
REFERENCE NO/CHECKNO.
A CAFEATE 200
NT NO SAP CUSTOMER NO DEALER NO TELEPHONE NOOTHER DETAILS 100

50
Mode of Payment Amount 20

CASH nWords figures S COINS

CHECK
TOTAL CASH PAYMENT
DEBIT MY ACCOUNT NO
PLEASE LIST EACH CHECK AND ENDORSE PROPERLY
BANK/BRANCH CHECK NO. AMOUNT
ACCOUNTHOLDERS SIGNATURE
921 E LA SALLE N 25705/2022 15:37:16 PUT ON18
012 544 5807 PHP 11,056.00
PABLG CESAR ESPINOZA LAFUENTE 1.000000 CS

TOTAL CHECK PAYMENT

11391382 THIS PAYMENT IS SUBJECT TO THE TERMS AND CONDITIONS COVERING THIS ACCOUNT
S SOUP RECE PT WHEN MACHINE VALIDATED 8 BP