TRANSACTION SLIP TRANSACTION SLIP

Date:________________ Date:________________
Bank: Bank:
Account Number: Account Number:
Account Name: Account Name:
Cellphone Number: Cellphone Number:
Purpose : Purpose :
Amount: Amount:
Service Fee: Service Fee:
Total: Total:

Customer’s Signature Processed By Customer’s Signature Processed By

By signing this form, I agree that the following information provided in this form is true complete By signing this form, I agree that the following information provided in this form is true complete
and accurate and accurate

A U Ricardo General Merchandise A U Ricardo General Merchandise

Brgy. Poblacion Buenavista Quezon Brgy. Poblacion Buenavista Quezon
5299-6771-5612-5100 5299-6771-5612-5100
Reference #: Reference #:
Time: Date: Time: Date:
AMOUNT TO SEND/RECEIVE: AMOUNT TO SEND/RECEIVE:

Agent Agent
Customer’s Copy Customer’s Copy

TRANSACTION SLIP TRANSACTION SLIP

Date:________________ Date:________________
Bank: Bank:
Account Number: Account Number:
Account Name: Account Name:
Cellphone Number: Cellphone Number:
Purpose : Purpose :
Amount: Amount:
Service Fee: Service Fee:
Total: Total:
Customer’s Signature Processed By Customer’s Signature Processed By
By signing this form, I agree that the following information provided in this form is true complete By signing this form, I agree that the following information provided in this form is true complete
and accurate and accurate

A U Ricardo General Merchandise A U Ricardo General Merchandise

Brgy. Poblacion Buenavista Quezon Brgy. Poblacion Buenavista Quezon
5299-6771-5612-5100 5299-6771-5612-5100
Reference #: Reference #:
Time: Date: Time: Date:
AMOUNT TO SEND/RECEIVE: AMOUNT TO SEND/RECEIVE:

Agent Agent
Customer’s Copy Customer’s Copy