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                                                                                       INVOICE


                                                        rd
                                                                      Amicable World LLC
                                             82-17 153 Ave. suite 205 Howard Beach, NY. 11414 ph 718-374-3917 fx 718-374-3921
                  Received by Amicable World on                                      W-4 employee’s billing for the Month of ____________________   20___

                1. Provide invoices during the first 6 days of the month for the previous month. All invoices received by AW by 6-th day of the month will
                   be paid on the last business day of the same month. Invoices submitted after 6-th day of the month will be paid on the last business day of
                   the next month.


            Therapist Name:_____________________________
            Therapist Address: _____________________________________________


           Child’s Name                                Hours              Rate per      Total
                                                       provided           hour




                                                                                                                                      Grand Total $:




                                                                                                    Signature ___________________________________ Date______________


             For Office Use Only:
This invoice cannot be paid due to:
        Gaps in services from _______ to_______ not explained for____________________________________
        Invoice submitted more than 60 days from date of service ______ ________________________________

				
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posted:7/15/2012
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