AZOLA - PAYMENT SUBMISSION FORM

Azola Payment Submission Form
Project *
Company *
Select *

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

Application Date *

Month Day Year
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 Name Last Name
Phone *
E-mail Address *
Attach Your Payment App *

Attach Pay App

Cancel of

Date Reviewed *

Month Day Year
Date
Response *
Billing Code
Approved Amount no Retainage *
Approved Amount w/ Retainage *
Retainage for Period *
Final Retainage *
Azola Billing Period *
Comments *
Reviewer Name *
Coded Payment App

Upload a File

Cancel of
Should be Empty: