Invoice for Contract Fee*
(*Invoice Travel Expenses on “Travel Expense Account” Form FACS BA-12 2/97)
Submit to: LaSIP Attn: Linder Dawson 1885 Wooddale Blvd 11th Floor Baton Rouge LA 70806 Contractor’s Name: Contract Number: Remit to address: City, State, Zip:
Date
Services Provided
Billing Amount
Total I hereby request payment for services rendered Contractor’s Signature Program Approval Date Date