Invoice

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					                                                                            P.O. Box 21281 ◊ Houston, TX 77226
                                                                           Phone 281-220-9216 ◊ Fax 281-864-4373
                                                                           www.assessmentsandmoreconsulting.com




      Independent Contractor Invoice
  Your Name:                                                                                        Date Submitted:


Evaluations:

    Date            District            Campus            Student Name                  Type of Evaluation (e.g., FIE, Psych., Bilingual      Fee
  Completed                                          (first name + last initial)          FIE, Bilingual Psych., OT, Speech)/Mileage




                                                                                                          Evaluations + Mileage Total:

Hourly Rate Work:

    Date of         District            Campus            Student Name                   Service (e.g., ARD, Counseling, FBA, BIP,            Time
    Service                                          (first name + last initial)       REED, Additional Assessment, Speech Services,       (to nearest
                                                                                                        OT Services)                       0.25 hour)




                                                                                                                           Total Time:
                                                                                   Total Time x Hourly Rate = Total Hourly Rate Work:
     Bill To: Assessments and More Consulting                                               Evaluations + Mileage Total:
                                                                                                    + Hourly Rate Work:
                                                                                                        = Invoice Total:
                      Make all checks payable to


      * Use additional lines or pages if necessary

				
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posted:10/24/2011
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