Billing Form Template - Excel

							                                          SUBCONTRACTOR REQUEST FOR PAYMENT                                                                               09/01/09
                                                 (One Request Per Month)

To:         Michael Roberts Construction Inc                                                  Invoice Date:
            1660 Dell Avenue
            Campbell CA 95008
            Main: (408) 374-3662 Fax: (408) 374-3667                                          Billing #                                     1

From:       Subcontractor                                                        XXX-XXX
            Street Address                                                                    Project:
            City                        State            Zip

        Ph: xxx.xxx.xxxx                             Fx: xxx.xxx.xxxx            Cost Code
                                                                                  XX-XXX      description
CONTRACT/BILLINGS

          1 Contract Amount                                                                    $                            -

                                        Change Order(s)
                                    #                                        $           -
                                    #                                        $           -
                                    #                                        $           -
                                    #                                        $           -

          2 Total Adjusted Contract Amount                                                     $                            -




          3 Amount Billed - This Invoice                 RETENTION BILLING

                           Invoice #                                         $           -

          4 Amount Previously Billed                                         $           -

          5 Total Billed - Project To Date                                                     $                            -           #DIV/0!




          6 Balance To Bill On Contract                                                        $                            -



RETENTION / NET PMTS DUE
                                                                                              Project To Date
            This Invoice                                                     RETENTION        Billed $ - Project To Date:                             $          -
            Billed $ - This Invoice                       $             -    $          -
                                                                                              -Retention-Previous Billings         $              -
            -Retention W/H @                        10% $               -    $          -     -Retention-This Invoice              $              -
                                                                                              +Retention Released To Date          $              -
            Net Pmt Due-This Invoice                      $             -    $          -     Total Retention Balance-Project To Date                 $          -
            Net Payment Due                                             $0.00
                                                         Backcharges         $           -    Net Billing - Project To Date                           $          -
            FINAL TOTAL                                                              $0.00

                                                                                              Balance Pmts Due On Contract                            $          -




            The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and belief, the Work covered
            by this 'Request for Payment' has been completed in accordance with the Contract Documents, that all amounts have been
            paid by the Contractor for work for which previous requests for payment were issued and payments received from the Owner,
            and that current payment shown herein is now due.
                                                                             Submitted by:

                                                                                              (Signature / Date)

                                                                             On Behalf of:
                                                                                              (Company name)




         39c9f5cc-1903-46a7-b07f-d45822bd6dcf.xls