A dark header with your business name and a large amount. The street is not printed, and there is no phone field.
The sample has a dark header with a shop mark and the business name. Date and time sit under it, then a large amount. A receipt number is on the right. Custom amount and total match. The payment line is under the total. A dark band sits above “Visit us in” and the city and state.
Custom amount and total are both the amount you type. A receipt number is filled in. The shop mark is part of this layout. It is not a logo you upload.
This is a Standard template. A current Standard or PRO membership removes the membership watermark. If you are not signed in, the receipt still shows that watermark. After you make the receipt, the page offers a JPG download and a PDF of that same image.
That line is the city and state field. The sample was filled with a phone number. This form has no phone field.