Laserfiche WebLink
B�CIM�ATE� PREVENTION PROCRAM <br />� INUOIC� CO�T' �F�EAKDOUVN <br />Piease use this I�voice Cost Breakdown as a tempiate for invoices submitted as part of the Backwaler <br />Prevention Devico rebate prograrn. Efther this fortn or your own invoice torm with the following line items can <br />be submitted. This allows you to invoice your client acoording to your existing bllling template while allowing <br />city statt to identity how costs eligible for the Backwater Prevention Device Rebate were accrued. <br />Only fa6ar and materi�ls direcBy refaled Qo fhe insQallaPion and iunction of a bachwater prevertdon <br />�evice a?e eiigi6le for CiPy relrate and PhePefore should be included on Qhe upper half oi this Pomt. <br />AddiNona! costs may be added fo boflom of the form. <br />Business Name: �l�-li- ��bit�hl��r i.! C _ License Number. i�}-l��l i/ l�� //��� <br />. <br />Business Mailing Address: <br />Phone: �S`!-�'y–U("z � — <br />Revised 9/03120i4 <br />