Bill and Invoice Payment Form
Company Name/Service
Provider_______________________________________________
Contact Person/Respresentative__________________________Phone_______________
Address:_________________________________________________________________
Event/Committee__________________________________________________________
Committee Chair/Representative______________________________________________
Date bill received__________________________ Date
Due_____________________
Description/In payment for__________________________________________________
________________________________________________________________________
________________________________________________________________________
Total Amount Due $_____________________________________
$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
For Treasurer's use Only
Check made payable to:_________________________________________________
Check #____________ Check amount $__________________
Date Issues/Mailed____________________/_________________
Account/Line Item Debited________________________________
Treasurer's Signature_____________________________________
Comments______________________________________________
_______________________________________________________