Tenant name

Amount received

Date received

Payment for

The month or dates this payment covers.

Rental address

Paid by

Check or reference number

Optional.

Balance still due

Leave at 0 if this payment covers everything owed.

Receipt number

Received by

Name and title of the person who took the payment, such as landlord or agent.

Rent receipt

No. 001

Date received

Received from

Amount

$1,800.00

One thousand eight hundred and 00/100 dollars

Payment for

Rental address

Paid by

Cash

Balance still due

$0.00 (paid in full)

Received by

Signature

Nothing you type here is sent or saved. Fields you leave empty print as blank lines to fill in by hand.