JPS6234780Y2 - - Google Patents

Description

[Detailed explanation of the invention] This invention relates to an automatic payment form, which is mainly used when paying so-called public charges such as electricity, gas, and water charges from a deposit account at a financial institution such as a bank by automatic transfer method. Regarding forms.

Traditionally, so-called automatic payment of public utility charges involves a deposit account transfer request form submitted by the rate payer to the financial institution and a form filled out by the financial institution in accordance with a format independently determined by the so-called public institution such as the electric power company, gas company, water bureau, etc. This is a two-pronged process along with the payment method change notification form to be submitted.
For this reason, there is double work involved in filling out the form by the rate payer and the financial institution, which can lead to transcription errors at the financial institution, discrepancies regarding requested items between the rate payer and the financial institution, and the public One drawback was that separate forms had to be prepared for automatic payments other than fees.

This invention eliminates the above-mentioned drawbacks and provides an automatic payment form that allows you to create a deposit account transfer request form and payment method change notification in one writing, and does not cause troubles such as transcription errors. The purpose is

In other words, the automatic payment form of the present invention overlaps multiple payment method change notification forms so that the vertical dimension gradually becomes shorter toward the top, and then stacks the payment method change notification forms on top of the payment method change notification forms. The transfer request form, which is longer in the vertical dimension than the payment method change notification form, which has the longest vertical dimension, is stacked together, and then the customer receipt paper is layered on top of that, and the top edge of each paper is aligned and separably bound. ,
Each of the payment method change forms has a field for writing common items on the upper part of the front surface, a field for writing special notes on the lower exposed part of the front surface, and a copying ink layer on the back side at a position corresponding to the field for writing common items, and a transfer request form. The form has a common item entry column in the upper part of the front surface corresponding to the common item entry column, and a special notes entry column is provided in the part corresponding to the special notes entry column of each payment method change notification form in the lower part of the front surface. It is characterized by having a column for entering additional items, a layer of copying ink on the back side at a position corresponding to the column for writing common items and a column for writing special notes, and a column for checking requested items on the front side of the customer slip. be.

Hereinafter, the present invention will be described in more detail with reference to the drawings.

FIG. 1 is an overall perspective view of the automatic payment form according to the present invention, in which payment method change notification forms 1, which are long in the vertical direction, payment method change notification forms 3, 5, 7, which are short in the vertical direction, 9 and 11, stack the transfer request form 13, which is longer in the vertical direction than the payment method change notification form 1, which is the longest in the vertical direction, on top of the payment method change notification form 11, and then the The customer receipt form 15, which is shorter in the vertical dimension than the payment method change notification form 11, which is shorter in the vertical direction, is stacked, the upper edge 17 of each sheet is aligned, and adhesive is applied to the cross section of the upper edge 17 of the paper, so-called. It is made of starch so that it can be easily separated.

As shown in Figures 2 to 7, the upper part of the front surface of each payment method change notification form 1, 3, 5, 7, 9, and 11 includes the address, name, name, and name of the financial institution of the person requesting the deposit account transfer. Provide common items entry columns 19, 21, 23, 25, 27, 29 common to each sheet such as numbers,
Special notes entry columns 31, 33,
35, 37, 39, 41 and confirmation stamp columns 43, 4
5, 47, 49, 51, and 53, and copies (not shown) are provided on the back side of the other forms except payment method change notification form 1 at positions corresponding to the common information entry columns 21, 23, 25, 27, and 29. Provide an ink layer.

As shown in FIG. 8, the above-mentioned common items entry fields 19, 21, 2
3, 25, 27, and 29 are provided with a common matter entry column 55, and the special matter entry columns 31, 3 are provided.
3, 35, 37, 39, 41 and confirmation stamp column 43,
45, 47, 49, 51, 53, special notes entry column 57, 59, 61, 63, 65,
67 and confirmation stamp columns, 71, 75, 77, 79 are provided, and an additional matter entry column 81 and a confirmation stamp column 83 are provided at the bottom, and the common matter entry column 55 and special notes entry column 57, 59, 61 are provided on the back side. ,63,65,67
A copying ink layer (not shown) is provided at a position corresponding to .

Note that the additional items entry column is a column in which insurance premiums such as pensions, rents such as public corporations, taxes, loan repayments, etc. can be entered arbitrarily as necessary.

As shown in FIG. 9, a request item check column 85 is provided on the front side of the customer receipt form 15, and notes 87 for the transfer payment requester are written on the back side, as shown in FIG.

In addition, the payment method change notification form 1, 3, 5, 7,
9 and 11 are notification forms to notify the Telegraph and Telephone Public Corporation, gas company, water bureau, etc. that the utility charges will be paid by bank transfer from now on, and transfer request form 13
is a request form for a payer of so-called public charges such as telegraph and telephone charges to request a financial institution such as a bank to transfer payment from a deposit account.
5 is a form that the financial institution hands over to the transfer payment requester to prove the requested items.

Next, we will explain how to use the automatic payment form of this invention. First, the transfer payment requester fills in the necessary information in the common items column, special notes column, additional items column, etc. on the transfer request form, and then checks the requested items on the customer receipt form for the items for which transfer payment is requested. Fill in the field. Then, the items entered on the transfer request form are copied onto each payment method change notification form using copying ink. Next, check the information entered on this automatic payment form at a financial institution such as a bank, stamp the confirmation stamp on each payment method change notification form and transfer request form, and keep the transfer request form as a copy at the financial institution. The customer receipt form is then delivered to the transfer payment requester, and the remaining payment method change notification form is delivered to each utility bill payee.

As explained above, in the automatic payment form of this invention, the most important transfer request form, which is used as a copy for financial institutions such as banks, is placed at the top, and it is written directly with a writing instrument. This completely eliminates the problem of characters not being copied due to weak writing pressure, such as when placing the font at the bottom, or characters becoming unreadable due to stains caused by rubbing of copying ink. The method change notification form is polymerized so that the vertical dimension gradually becomes shorter as it goes to the top, and a space for writing special notes is provided in the exposed part of each form, and a transfer request form is written in that space. Since the copying ink layer provided on the back side of the paper is in contact with the paper, the items entered in the transfer request form can be clearly copied on all the payment method change notification forms located from the top to the bottom. In addition, as mentioned above, the invention of the present application has a common entry field for all of the transfer request form at the top and each payment method change notification form, and is configured so that each can be copied. By just filling out information once, the same information can be copied onto all forms, thereby saving the time and effort of transcription and eliminating the troubles caused by conventional transcription errors. Furthermore, a confirmation stamp field will be provided in the special notes column of each payment method change notification form, each special notes column and additional notes column of the transfer request form, and a request item check column will be provided on the front of the customer receipt form. Since the precautions are written on the back side, it is possible to completely prevent any discrepancies between the transfer payment requester and the financial institution regarding the transfer payment request items, which may lead to trouble.

Furthermore, the automatic payment form invented in this application has a field for entering additional information on the transfer request form, and although it does not require a payment method change notification form, it can be used as an automatic payment form. There is no need to prepare a form.

[Brief explanation of the drawing]

Fig. 1 is an overall perspective view of the automatic payment form of the present invention, Figs. 2 to 7 are plan views showing the front surface of each payment method change notification form, and Fig. 8 is a plan view showing the front surface of the transfer request form. , FIG. 9 is a plan view showing the front surface of the customer receipt sheet. 1, 3, 5, 7, 9, 11... Payment method change notification form, 13... Transfer request form, 15... Customer receipt form, 19, 21, 23, 25, 27, 29...
Common items entry column, 31, 33, 35, 37, 3
9, 41... Special notes entry column, 43, 45, 4
7, 49, 51, 53...Confirmation stamp column, 81...Additional information entry column.

Claims (1)

[Scope of Utility Model Registration Request] (1) One or more payment method change notification forms with shorter vertical dimensions are stacked on top of payment method change notification forms with longer vertical dimensions, and Lay the transfer request form, which is longer in the vertical direction than the payment method change notification form with the longest vertical dimension, on top of it, and then place the transfer request form, which has the shortest vertical dimension in the vertical direction, than the payment method change notification form. Stack customer slips with a short length and staple them separably with the top edges of each sheet aligned, and provide a space for writing common items on the upper part of the front surface of each payment method change notification form, and a space for writing special notes on the exposed lower part of the front surface. A layer of copy ink is provided on the back side of the other forms, except for the payment method change notification form located at the bottom, at positions corresponding to the common information entry fields, and the above-mentioned payment method change information is provided on the upper part of the front surface of the transfer request form. A common matter entry field is provided in the section corresponding to the common matter entry field on the notification form, a special matter entry field is provided in the section corresponding to the special notice matter entry field, an additional matter entry field is provided at the bottom of the front surface, and the above-mentioned common matters are provided on the back side. An automatic payment form characterized in that a copying ink layer is provided at positions corresponding to entry columns and special notes entry columns, and a request item check column is provided on the surface of the customer slip. (2) Automatic payment as set forth in paragraph 1 of claims for utility model registration, characterized in that a confirmation stamp field is provided in the special notes entry field and the additional matter entry field of each payment method change notification form and transfer request form. ledger.