(Sample Invoice) 21st Century
Purchase Order #: CS0901234 Invoice Number: 35857 Phase: 5 Date: August 7, 2008 To: Los Angeles Unified School District Attn: Avalon / Beyond the Bell Branch 333 S. Beaudry Ave. 29th Fl Los Angeles, CA 90017 Payee: XYZ Agency 1808 N. Alexandria Av. Los Angeles, CA 90044
Contact Person: Phone: Fax: Contract Number:
BTB Use Only Program / Accounting Line
Joe Bryant (213) 987-6543 (213) 987-6542
0901234-B
Dates Apr – June ‘08
Service Rendered Ben Franklin High School Percentage billed __20%__
Total
$ 42,000.00
TOTAL AMOUNT $ 42,000.00 Please remit payment to: XYZ Agency 1808 N. Alexandria Av Los Angeles, CA 90044 Date:
(Signature) Agency Director’s Name Name, Title
SPONSOR (BEYOND THE BELL): I certify that the services listed above were satisfactorily rendered in accordance with the contract requirements and I hereby approve this invoice for payment.
Signed: Title:
Dorothy Padilla Director
Date: School/Office:
BTB
COMPLETED INVOICES SHOULD BE FORWARDED TO THE BEYOND THE BELL BRANCH. INVOICES SHOULD NOT BE SENT TO THE CONTRACT OR ACCOUNTS PAYABLE SECTION.