ARTIST INVOICE FORM

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					                              ARTIST INVOICE

NAME _________________________________________________________


ADDRESS ______________________________________________________


CITY ___________________________ STATE ___________ ZIP _________


SOCIAL SECURITY # _____________________________________________


PHONE _____________________ E-MAIL ____________________________


PLACE OF SERVICE ______________________________________________


COUNTY _______________________________________________________


DATES OF SERVICE _____________________________________________


AMOUNT _______________________________________________________


MILEAGE (over 30 miles in each direction)_________________________

* Please include Expedia form beginning at your home address ending with the
site destination address. If this is not included, no mileage will be paid.*


ARTIST SIGNATURE ______________________________________________



                        4202 East Folwer Avenue, EDU 105
                              Tampa, Florida 33620
                                  813-974-0712
                                mfarber@usf.edu
                               FAX: 813-905-9878

				
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