Business Name: Date:
Address: Technician:
City: Time In:
State:

Zip Code:

 Time Out:
Attention: Total Time:
E-Mail: Labor Rate:
Phone: Total Labor:
 
Item 1: Item 1 Cost:
Item 2: Item 2 Cost:
Item 3: Item 3 Cost:
Item 4: Item 4 Cost:
Item 5: Item 5 Cost:
Item 6: Item 6 Cost:
Subtotal Material Cost:
6% IN State Tax:
Total Material Cost:
 
Miscellaneous: Misc. Chg:
 

Terms and Conditions:  
Payment Terms are NET 15 days from invoice date and any invoice not paid in 30 days is subject to late payment finance charge of 5% per month
 

Grand Total:

This is a work order only - an invoice will be mailed to you. Please do not pay from this form.
 

Description
 of Work: