CP 3 -- Continued
D. Site Visits for each RATE should be shown individually i.e.:
AUTHORIZED #______ visits @ $_______ = $________
____ visits @ $_____ = $______ This Invoice .............. $________
____ visits @ $_____ = $______ Previously Invoiced ..... $________
TOTAL AMOUNT EARNED ................................... $________
LESS PREVIOUS PAYMENTS ................................ $________
AMOUNT DUE ..................................................... $________
Payment of the above amount now due is hereby requested.
Payee
(Name of A/E)
Per
(Signature)
Title
NOTE: Reimbursable Items shall be invoiced separately.
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