Separate before paying in

Receipt

Account / Payable to

CH44 3199 9123 0008 8901 2
Thomas LeClaire
Rue examplaire 22a
1000 Lausanne

Reference

12 34567 89012 34567 89012 34567

Payable by

Thomas LeClaire
Rue examplaire 22a
1000 Lausanne

Currency

EUR

Amount

Acceptance point

Payment part

Currency

EUR

Amount

Account / Payable to

CH44 3199 9123 0008 8901 2
Thomas LeClaire
Rue examplaire 22a
1000 Lausanne

Reference

12 34567 89012 34567 89012 34567

Payable by

Thomas LeClaire
Rue examplaire 22a
1000 Lausanne