ACCOUNTS RECEIVABLE REPORT

Client Identification: ____________________________________________________

Address: _____________________________________________________________

Contact Name: ________________ Phone: _____________________

Receivable on file:

Under 30 days 30 to 60 Days 61 to 90 Days Over 90 Days

_______________ _____________ _____________ __________

Total receivables: ______________________________________________________ Allowable credit limit on receivables: _______________________________________

Is client over allowable credit limit? ________________________________________ Does this client have a payment agreement? If so, specify term:

_____________________________________________________________________

If no payment agreement exists, specify action to be taken to insure payment and/or a continued business relationship:

_____________________________________________________________________ _____________________________________________________________________

___________________________________

Accounts Receivable

__________________

Date