PAYMENTS REQUEST.

Reference Number

Please use your Initials for the first 2 digits

Date

YYYY

Requested By

Name of Requesting the Payment

First Name

Last Name

Total Amount

Enter Amount including GST (if any)

GST Amount

Enter GST Amount, or $0.00 if none

Payment Type

Payment Category

Payment Purpose

Make Payments To:

Name of person or company to be paid

Bank Account Number

Enter BSB / Account Number (for the New Recipient)