Home Modification Loan Program Invoice

Home Modification Loan Program

Contractors need to supply detailed back-up documentation on their letterhead
Date*

MonthDayYear
Date
Invoice #*
Property Owner Name*
Address of Project*
Name of General Contractor*
Contractor Mailing Address*
Contractor Work/Cell*
Please enter a valid phone number.
Contractor Work/Cell/Fax
Please enter a valid phone number.
Contractor Email*
example@example.com
Description of Materials and Labor (milestone identified with payment schedule on bid form): Please include manufacturer and model # (s) for major components as listed on the bid form.*
Total Project Cost listed on Bid Form:   $*
Approved Change Orders (if applicable):  *
Revised Project Cost (if applicable): *
Total Paid To-Date:     *
Current Payment Due: *
Contractor Signature

Clear
First disbursement only, I authorize the purchase of the above materials before the start of workI agree all work listed above is complete to my satisfaction
Homeowner(s) Signature

Clear
(Provider Use Only)
Verified by: Email Phone Mail on Date with homeowner prior to issuing check.
Total Invoices Paid to Date:
Should be Empty: