Payment Application Request Construction

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					PAYMENT APPLICATION
TO: PROJECT: NAME AND LOCATION: FROM: DATES FOR WORK: ARCHITECT: APPLICATION NO: PROJECT NO:

FOR: CONTRACTOR’S SUMMARY OF WORK

CONTRACT DATE:

Application for payment as shown below: Continuation Page is attached:
1. CONTRACT AMOUNT $__________________________ 2. CHANGE ORDER TOTAL $__________________________ 3. TOTAL CONTRACT AMOUNT (Add lines 1&2) $__________________________ 4. TOTAL COMPLETED AND STORED (COLUMN G ON CONTINUATION PAGE) $________________________ 5. RETAINAGE: a. 10.00% of Completed Work $________________ b. 10.00% of Material Stored $________________ Total Retainage (Line 5a + 5b or Column 1 on Continuation Page
				
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