Laserfiche WebLink
�� <br />� <br />,�,: <br />BACKWATER PHEVENTION' PROGRAM <br />INVOICE COST BRIEAKDOVIIN <br />Please use this Invoice Cost P.��ekdown as a;emplate for invoices submieed as part of the Backwater <br />Prevention Device rebate pro�ram. Either lhis form or your own invoix fortn with the following line items c�,n <br />be submAted. This allows you to i�woice your ciient ar.cording to your existing billing template while allowinq <br />cily staff lo identify.how cosls eligibte for Ihe Dackwater Prevention Device Rebate were accrued. <br />Oril,v labor and materials direcNy refated to the installafion and function of a backwater prevenfion <br />device are eligible /or City rebate and fhere/ore should be included on the upper ha110/ this /orm. <br />Addifional co�ts may be added fo bottom ot 1he lorm. <br />Business Name: <br />Business Mailing Address: <br />Number: f�-A- Ul u �'iC��t�� <br />Phone: L12� '-1��I—DlZ3 Email:_(�AJ✓Vh�'tn te.ev� �LCir►r�l <br />Revised 9/03/2014 <br />