Help me put the information into the bank deposit slip

Daily Transaction Report: Date 11/6/20xx 11/6/20XX 11/6/20XX 11 /6/20xx 11/6/20XX 11/6/20XX 11/6/20X,x 11/6/20XX 11/6/20XX 1 116/20XX 11/6/20xx 1 1 /6/20XX 11/6/20XX 11/6/20XX 11/6/20XX Total Patient Reuven Ahmad Amma Patel Ken Thomas Maude Crawford A1 Neviaser Julia Berkley Jana Green Kyle Reeves Truong Tran Quinton Brown Tai Yan Ella Rainwater Diego Lupez Carl Bowden Noemi Rodriquez Account 11872534 12156063 11644627 12568850 11279412 12062515 10944532 12073635 11726005 11272882 12658901 11885104 12530423 11265329 11766543 Cash $25.00 $15.00 $40.00 $25.00 $30.00 $135.00 Check $89.00 $136.00 $1366.65 $650.36 $890.22 $3132.23 Debit/Credit S150.oo $300.00 S75.oo S25.oo S45.oo S595.oo DEPOSIT TICKET WALDEN-MARTIN FAMLY MEDICAL CLINIC 1234 ANYSTREET ANYTOWN, ANYSTATE 12345 DEPOSITS MAY NOT BE AVAILABLE FOR IMMEDIATE WITHDRAWAL Clear Water Bank Anytown, Anystate ACCOUNT NUMBER: 123-456-78910 Endorse & List Checks Se aratel Dollars DATE CURRENCY Cents COIN 2. 3. 4. 5. 6. 7. 8. 9. 10. II. 12. Total Items TOTAL CASH Less Cash Returned Total De osit CamScanner