American Care Pro: Contractor's Billing Statement

AMERICAN CARE PROFESSIONALS
A Senior Care Referral Agency
22102 Normandie Ave, Torrance, CA 90502

For questions about this form, please call
Lou Samson at 310-938-9393

Please complete this form ONCE for each billing period for submission to the American Care Professionals Trust Account.

Submit NO LATER THAN TWO DAYS after the last day of the billing cut-off.

PERSON SUBMITTING THIS FORM*

First NameLast Name

EMAIL*

example@example.com

PHONE NUMBER*

Area CodePhone Number

Enter your serviced days. Fill in ONE DAY AT A TIME. Tap " ADD SERVICED DAYS" for your additional worked days.

SERVICED DAYS*

REIMBURSEMENT / MILEAGE / OTHER CHARGES

Note: Reimbursement will only be processed with a copy of the receipt.

Upload Receipt

Type your notes / questions:

Type a question