SENDER COMPANY NAME Sender company address
Date	FAX
To: Recipient name
Phone number: Recipient phone number
Company name: Recipient company name
Fax: Recipient fax number
From: Sender name
Phone number: Sender phone number
Company name: Sender company name
Fax: Sender fax number
Number of pages: Number of pages sent
Urgent: Yes or No
Action requested: Enter action required