$OWNER_NAME	$INSTITUTION_NAME		$DATE
	$OWNER_ADDRESS	$INSTITUTION_STREET
	$OWNER_CITY $OWNER_STATE	$INSTITUTION_CITY
Pay	$AMMOUNT_STRING			$AMMOUNT_DECIMAL
To the order of	$PAYEE_NAME		Per	$MEMO
	$PAYEE_ADDRESS
	$PAYEE_CITY $PAYEE_STATE