Ad Agency Line Item Invoice - Excel

							                                               WV Division of Tourism                                                                    Page __ of__
                                      Matching Advertising Partnership Program
                                            Reimbursement Summary Sheet

Mailing Address:                                Internet: callwva.com
WV Division of Tourism                          Connie Rosenbaum 558-2288 X 322
Attn: Les Smith
90 MacCorkle Ave., S.W.
So. Charleston, WV 25303


Grant #:                                                         Name of Applicant:
Date:                                                            Project Name:


1. Group expenses by budget line item, I.e., media, production, printed material, etc.
2. List each vendor invoice separately. Itemize all expenses reflected in your request.
3. Amounts listed below must equal amounts reflected on the Reimbursement Request Form.
4. Attach all required documentation as specified in the instructions on the web.
5. Assemble documentation in the same order as items are listed on this summary sheet.


Line Items & Expense        Vendor Invoice # Ad Agency           Invoice Amt.       Amount            Check #    Name of Vendor          Attachments
     Description                                Inv. # (If Ap-                      Requesting                                           (Described)
                                                plicable)                           Reimb for
Examples
1. Media/ TV ad 3/1/04-     14-1786             8829562          $   10,500.00      $      4,462.50        15840 WV Broadcasting, LLC    CD
3/31/04-30 sec. spots                                                               (Net amt. Only)
2. Print/Ad in 6/15/04      15763               N/A              $    1,800.00      $        900.00        15843 Charleston Newspapers   6/15/2004
edition                                                                                                                                  Tearsheet
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Total Amount Requesting:                                                            $

Attach additonal sheets as needed
                                                                                                        8/15/2005 Reimbursement Forms\Summary Sheet-44