Business Account Number:

Check the type of payment received:

Check Customer's Check Number

Credit/Debit Card

Cash

Bank Wire Transfer/Adjustment

Enter Transaction Date: (Enter as xx/xx/xx)

Enter Amount Received: $

Category/Description of Income You Wish To Track (optional): (for example, you could track a job number, project number, customer number, type of merchandise sale, type of service revenue - these are just a few examples)

If Amount Received Includes Collected Sales Tax:

Revenue and Charges Subject to Sales Tax      $

Revenue and Charges Exempt from Sales Tax $

Sales Tax Collected:                                      $

The sum of these three figures should equal the Amount Received that you entered above.