Form Ador 10847 - Collection Information Statement For Businesses Page 10
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10Arizona Department of Revenue
Collection Information Statement for Businesses
Business Name
SUPPLEMENTAL PAGE:
Accounts/Notes Receivable
List additional accounts not listed on page 5.
ACCOUNTS/NOTES RECEIVABLE. List all contracts separately, including contracts awarded but not started.
Description
Amount Due
Date Due
Age of Account
0 - 30 days
A)
Name
$
30 - 60 days
Street Address
60 - 90 days
City, State, Zip
90+ days
0 - 30 days
B)
Name
$
30 - 60 days
Street Address
60 - 90 days
City, State, Zip
90+ days
0 - 30 days
C)
Name
$
30 - 60 days
Street Address
60 - 90 days
City, State, Zip
90+ days
0 - 30 days
D)
Name
$
30 - 60 days
Street Address
60 - 90 days
City, State, Zip
90+ days
0 - 30 days
E)
Name
$
30 - 60 days
Street Address
60 - 90 days
City, State, Zip
90+ days
0 - 30 days
F)
Name
$
30 - 60 days
Street Address
60 - 90 days
City, State, Zip
90+ days
0 - 30 days
G)
Name
$
30 - 60 days
Street Address
60 - 90 days
City, State, Zip
90+ days
0 - 30 days
H)
Name
$
30 - 60 days
Street Address
60 - 90 days
City, State, Zip
90+ days
0 - 30 days
I)
Name
$
30 - 60 days
Street Address
60 - 90 days
City, State, Zip
90+ days
0 - 30 days
J)
Name
$
30 - 60 days
Street Address
60 - 90 days
City, State, Zip
90+ days
Page 5
K)
Subtotal Receivables: List here and on page 5, line k .....
K) $ _______________
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Parent category: Financial