1 Detach and return this remittance form with your your payment.\\
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5 \makebox{ \includegraphics{[@-- $conf_dir --@]/logo.eps}} &
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6 \begin{minipage}[b]{5.5cm}
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7 [@-- $returnaddress --@]
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10 \begin{tabular}{r@{: }lr}
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11 Invoice date & \textbf{[@-- $date --@]} & \multirow{4}*{
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13 \begin{minipage}[t]{5.0cm}
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14 \textbf{[@-- $payname --@]}\\
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15 \addressline{[@-- $company --@]}
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16 \addressline{[@-- $address1 --@]}
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17 \addressline{[@-- $address2 --@]}
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18 \addressline{[@-- $city --@], [@-- $state --@]~~[@-- $zip --@]}
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19 \addressline{[@-- $country --@]}
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21 Customer\#& \textbf{[@-- $custnum --@]} & \\
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22 Total Due & \textbf{[@-- $balance --@]} & \\
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23 \rule{0pt}{2.25em}Amount Enclosed & \rule{2cm}{1pt}& \\
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27 \addressinset \rule{0.5cm}{0cm} &
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29 \begin{minipage}[t]{5.0cm}
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30 [@-- $returnaddress --@]
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