Sample Acknowledgement Receipt of Payment

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Acknowledgement Receipt

Use this template to create a receipt providing acknowledgement of payment. This sample may be used for a salary advance by an employer to an employee, personal loan between family or friends, or any cash payment between two or more parties that you need to document with a receipt.

Acknowledgement Receipt of Payment

Acknowledgement of
Payment Receipt

Receipt #

________________________________

Date:

________________________________

Total Amount of Money

________________________________

Type of Payment
[ ] Cash
[ ] Check - No. _____
[ ] Money Order - No. _____

Money to be Used For

____ ___________________________

____ ___________________________

Terms and Conditions

________________________________

________________________________

Repayment Agreement

________________________________

________________________________

Money Received by

________________________________
Name

_______________________ Date_____

Money Provided by

________________________________
Name

_______________________ Date_____