Laserfiche WebLink
BACKWA�'ER PREVENTION PROGRAM <br />INVOICE COST BREAKDOWN <br />Please use this Invoice Cosl 8reakdown as a tempiale for invoices submitted as part of the Backwater <br />Prevention Device rebate program. Either this form or your own invoice form witn the followinc� line items can <br />be suhmitted. This allows you to invoice your client according to your existing billing template while allotivirig <br />city slaH to identify how costs eligible for the Backwater Prevontion Device Re6ate were accrued. <br />Only la6or and materials directly related fo the Installation and function of a G e aIf o�hls fotRio�n <br />device are eligible for Ciry rebate and therefore should 6e included on the upp <br />Addifional costs may be added to bottom of the form. �/ <br />��'tc3l'� L ����r� <br />Bus�ness Name:�r; r�" �� t.�_�iL�e License Number. _���71— ^-_ <br />Businass Mailing Address: of(cz-lc LGzr(� v� i ��`-• � ������"—' — State Zip <br />Y <br />Phone:��';�c� -- �)� �. Email:���n m�r�<n�.l�1i1�Un�.�,d�' �1'� � p.l ; C'67i9 <br />Revised 9/03/2014 <br />