AZOLA - PAYMENT SUBMISSION FORM

Azola Payment Submission Form
Project*
Work Order Number
Company*
Select*

Contractor/ConsultantVendorAzola Only
NOTE: Submit your SIGNED Waiver of Liens with your next Payment Application.

Application Date*

MonthDayYear
Date
Pay App/Invoice #*
(5th Payment)
Billing Period*
Month You Are Billing
Dollar Amount*
Please add your dollar amount.
Description*
Ex. Invoice for plumbing.
Full Name*

First NameLast Name
Phone
E-mail Address*
Attach Your Payment App/Invoice

Cancelof

Date Reviewed*

MonthDayYear
Date
Response*
Billing Code
Approved Amount no Retainage*
Approved Amount w/ Retainage*
Retainage for Period*
Final Retainage*
Azola Billing Period*
Comments*
If receipt, describe purchase
Reviewer Name*
Coded Payment App

Cancelof
Should be Empty: