This document appears to be a check from Banco Colgate-Palmolive with fields for the account number, customer account code, payee name, signature, document number, written amount, and date. The date is noted to be written out in letters.

1. Entidad
Oficina
D.C
No. Cuenta
Cod. Cuenta del cliente
BANCO COLGATE-PALMOLIVE
Pta________________________________________________
Paguese por este cheque a:______________________________________________________________________________
_______________________________________________________________________________________________________
Firma___________________________________No. Documento__________________________
La cantidad de__________________________________________________________________________________________
_______________________________________________________________________________________________________
Fecha:______________________________________________________________
(La fecha debe consignarse en letra)
No. 321-0403-1987