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| Title | Carrier's Statement |
| FormNumber | 4245 |
| Revision | c1954 (01) |
| Division | |
| WhereUsed | envelope for carrier to collect money from customers |
| EKU | 1955 Agath |
| LKU | 1999 DLS |
| Notes | Two typesetting variants, believed from the mid 1950s: This one bolder, larger font. Title text is 2.75 mm x 40 mm. Last two lines of itemized statement have "due" all lower case. Cut to reverse flap slightly different. |
| Source | SS |
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