, check, credit card), and the payment amount. Learn what an acknowledgement receipt is and how to create one for your business (with a template and two examples).The sample acknowledgement letters for receipt of payment provided below can be used as format templates for official and personal purposes. Below are some receipt acknowledgment letter templates that you can download for free and help you get started. This document is a receipt acknowledging payment received from an individual or entity. This form is used to set up direct deposit for child support payments. JPS offers Financial Assistance to eligible individuals. We serve the healthcare needs of all patients, regardless of ability to pay. SAMHSA funds may not be used to pay for HIV treatment, viral hepatitis treatment, primary care services, PrEP, or PEP. • All necessary forms, enrollment fees, first week's tuition payment, and all prior balances are due before your child may begin.