Attachment 9 - Sample Receipts.docx
DOCX document 31 KB Posted
- Attached to
- Statewide E-Payment Services State and local contract opportunity
- Solicitation number
- 300000210291259
- Issued by
- Missouri
About this file
This file is Attachment 9 to a Statewide E-Payment Services solicitation issued by the State of Missouri, containing sample receipts demonstrating three payment processing methods accepted by the Missouri Department of Revenue. The document illustrates transaction examples for internet purchases via credit card, point-of-sale transactions using debit cards, and eCheck payments through ACH debit entries. Each sample receipt displays transaction details including customer identification numbers, timestamps, payment method information, transaction amounts, applicable fees, service descriptions, and charge descriptions as they appear on customer accounts. The receipts represent real-world transaction formats that payment service providers must accommodate and process.
The sample receipts demonstrate fee structures associated with payment processing, including convenience fees ranging from $1.33 to $1.50 for card-based transactions and DMV processing fees. The eCheck receipt includes specific authorization language indicating that the third-party processor is authorized to initiate ACH debit entries and reserves the right to pursue collection actions, including returned check fees, in cases of insufficient funds or inaccurate account information. These samples establish baseline expectations for receipt formatting, fee disclosure, transaction tracking, and payment method documentation that prospective bidders must understand to comply with the state's e-payment services requirements.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| STATE 0000000254SL - Statewide E-Payment.docx | DOCX document | |
| STATE 0000000254SL - Exhibit C - Pricing Page.xlsx | XLSX spreadsheet | |
| Attachment 1 - FY24 E-Payment Transactions and Data.xlsx | XLSX spreadsheet | |
| Attachment 2 - FY24 E-Payment Transactions by Card Type.xlsx | XLSX spreadsheet | |
| Attachment 3 - Sample IVR Script.doc | DOC document | |
| Attachment 4 - Sample Requested Daily Transaction Files Report.xlsx | XLSX spreadsheet | |
| Attachment 5 - Sample Data File Types - Various State Agencies.doc | DOC document | |
| Attachment 6 - Sample Data File Types - DOR.docx | DOCX document | |
| Attachment 7 - Sample Data File Types - DOR Motor Vehicle.xlsx | XLSX spreadsheet | |
| Attachment 8 - Sample Data File - EFT.docx | DOCX document | |
| Attachment 10 - Safeguarding Federal Tax Information.docx | DOCX document | |
| Attachment 11 - Admin Fee Report.xlsx | XLSX spreadsheet | |
| Attachment 12 - Missouri Statewide Contract Quarterly Usage Report.xlsx | XLSX spreadsheet |
Show all 13
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Text version
ATTACHMENT 9 – SAMPLE RECEIPTS
1) A sample receipt via an internet purchase follows:
Receipt Missouri Department of Revenue
7/2/2013 - 12:07:00 AM (CT)
Customer Name
20632267
7/2/2013
Web
Credit Card #
# XXX ####
$44.25
$1.33 convenience fee
$45.58
Renewal Fee (G7137781) - $40.75
DMV Processing Fee (G7137781) - $3.50
The charge will show on your account as :
Missouri Department of Rev
2) A sample receipt via a Point-of-Sale follows:
Receipt
7/2/2013 - 2:40:00 PM (CT)
Customer Name
12825705
7/2/2013 face-to-face (scan)
Debit Card #
# XXXX ####
DF45860027
$54.50
$1.50 convenience fee
$56.00
DMV : JC CO
(99999) - $54.50
The charge will show on your account as: Missouri Department of Revenue
3) A sample eCheck POP receipt (currently provided only for the Department of Agriculture) is below:
Receipt
7/2/2013 - 8:35:00 AM (CT)
Customer Name
12823301
7/2/2013 face-to-face (scan) eCheck
Account number XXXX####
DF2731 03
$27.75
DMV : JC CO
(99999) - $27.75
The charge will show on your account as :
MO DMV POS
This receipt reflects your authorization for Department of Revenue’s third party processor to initiate an ACH debit entry to the above designated bank account for the Total Remitted specified. In the event the third party processor is unable to secure the funds for this transaction from your account for any reason, including but not limited to insufficient funds in your account or insufficient or inaccurate information, further collection action may be undertaken by the third party processor including any application of returned check fees to the extent permitted by law.
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File details come from the government source that posted it. Updated .