SAMPLE INVOICE TEMPLATE Clause Samples

SAMPLE INVOICE TEMPLATE. Senior Non-Emergency Medical Transportation Program A. Non-Ambulatory Transportation ServicesB. Non-Ambulatory Transportation ServicesC. Transportation Services Curb-to-CurbD. Transportation Services Door-to-Door Curb-to-Curb Door-to-Door 0 0.00 N/A Less Project Income Balance: TOTAL REIMBURSEMENT: Month Subtotal PreviousTo Date Contract To Date Client Collections Fundraising Donations In-Kind Contributions Total $0.00 $0.00 $0.00 Unreimbursed mileage subsidized with contributed funding: MonthSubtotal Previous To Date Contract To Date Rate Mileage Total 0.0 $0.00 $0.00 $0.00 Contributed funding for unreimbursed mileage remaining balance = $0.00 FOR COUNTY USE ONLY: ACCOUNTING CODE Reimbursable Advance/Reversal FUND DEPT BUDGET CONTROL UNIT OBJ REV BSA SUB-OBJ SUB-REV SUB-BSA DEPT OBJ DEPT REV DEPT BSA JOB NUMBER AMOUNT Performance Line No. July Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun FY To Date