HomeMy WebLinkAboutUpdated Invoice Request - 163 SerranoFinance & Information Technology
Invoice Request Form
Date:
Requested By:
Please bill the following individual or organization:
Name
Mailing Address
City State Zip
Attention
Place payment in Revenue Account:(Not an Expenditure Account)
Amount to be billed:
This charge is:One-Time Recurrent
Description of what is being billed:
IE. Damage to City Property due to accident
Three trees replaced @ $150.00 each
Labor of one Tree Specialist for six hours
@ $60.00 per hour
Issuing Department:*
Contact Name:*
Contact Phone Number:*
* These items will appear on the invoice for customer inquiry.
Special Requests:
Include attached documents with the invoice
Notify contact when payment is received
If not paid within 60 days forward to collection agency
If not paid within 60 days notify contact
Special Instructions:
Is this associated with a CIP?
If so, what is the account number?