Laserfiche WebLink
BACKVII�►TER PREVCNTION PRC��RANi <br />� INVOICE COST BREAKDOWN <br />Please use this InvbiCe Cost Breakdown as a template for invoices submitled as part of the Backwater <br />Provention Device rebate program. Eilher this form or your own invoice form with lhe following line items can <br />be submitted. This allows ycu to Invoice y��ur client according to your existing billing template while allo�ving <br />city st5if to idenlify itow Costs eligible for lhe Backwater Provention Device Rebate v�ere accrued. <br />Onfy labor and materda/s dlrectly related to the installation and funclion of a backwaterprevention <br />devlce are eligi6le for Clty rebate and thercfore should be included on the upper haff of this form. <br />Addifional costs y be a_dded o boitom of the fcrm. �� �, J� * � <br />(��UJG��� r�+� r�/ <br />Dusiness Name: Rhd LV` _ License Number: n _� <br />Buslness Mailing Address: ��' ' ryl����"' �''t� "' -`!� ✓'��' '`''-`"` <br />��- L1�5' yJ�(� �1_tf��'��,��—��e �=Z�c� <br />Phone: [mail: o , -o � c �,�1PX' C� (�'��u � /'✓1 <br />Revised 9/03/2014 <br />