AZOLA - PAYMENT SUBMISSION FORM

Azola Payment Submission Form
Project
Work Order Number
Select
Company
Company Other
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: