Tabular Statement of Account Template
ACCOUNT NUMBER
BILL NUMBER
DATE DUE
BILLING DATE
FROM:
PAY THIS AMOUNT
TO:
DA FORM 1857, JUN 1983
APD LC v2.00
STATEMENT OF ACCOUNT
For use of this form, see AR 37-108; the proponent agency is USAFAC.
MAKE CHECKS PAYABLE TO TREASURER OF US
(Present or mail this portion of the bill with the payment.)
DETACH THIS PORTION OF BILL
DATE AMOUNTDESCRIPTION OF CURRENT CHARGES
Balance Forward Current Charges Taxes Interest Penalty Processing
(3 Part)
EDITION OF 1 AUG 71 IS OBSOLETE
1
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Tabular Statement of Account Template PDF
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