Detach and return this remittance form with your your payment.\\
\begin{tabular}{ll}
\begin{tabular}{ll}
\returninset
\begin{tabular}{ll}
  \makebox{ \includegraphics{[@-- $logo_file --@]}} &
  \begin{minipage}[b]{5.5cm}
[@-- $returnaddress --@]
    \end{minipage}
\end{tabular}&
\begin{tabular}{r@{: }lr}
Invoice date & \textbf{[@-- $date --@]} & \multirow{4}*{
\makebox{
\begin{minipage}[t]{7.0cm}
\textbf{[@-- $payname --@]}\\
\addressline{[@-- $company --@]}
\addressline{[@-- $address1 --@]}
\addressline{[@-- $address2 --@]}
\addressline{[@-- $city --@], [@-- $state --@]~~[@-- $zip --@]}
\addressline{[@-- $country --@]}
\end{minipage}}}\\
Customer\#& \textbf{[@-- $custnum --@]} & \\
Total Due & \textbf{[@-- $balance --@]} & \\
\rule{0pt}{2.25em}Amount Enclosed & \rule{2cm}{1pt}& \\
\end{tabular}\\
\rule{0pt}{1cm} &\\
\end{tabular}\\
\begin{tabular}{ll}
\addressinset \rule{0.5cm}{0cm} &
\makebox{
\begin{minipage}[t]{7.0cm}
[@-- $returnaddress --@]
\end{minipage}}
\hfill
\end{tabular}\\
\end{tabular}\\