Required Information for Invoice Preparation

Required Information for Invoice Preparation Today's Date Print Form Submit by Email 5/12/09 Email/print directly from form, or Save pdf & email as an attachment to Jenny: jmerrifi@healthy.uwaterloo.ca If you have any questions please do not hesitate to contact me (BMH 1107 ext. 32917) Customer/Company/Organization Address City Prov/State Ontario Postal code Country Canada Date service was performed/provided Contact Person/Attn Email Phone Number Fax Number Description of ServiceProvided Cost per Unit/Hr # of Units/ Hrs GST/PST required? Total $ Commments/ Instructions (Will not appear on Invoice) Account to be credited Documentation attached * Documentation to be sent at a later time *Please provide some documentation stating the request for or the agreement to provide the service (s) to be billed

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