CCSU FOUNDATION, INC.
INVOICE
Service performed
I certify that the above information is accurate and that the service was performed as indicated.
_________________________________
Date
_________________________________
Date
Date(s) of service
Amount due for service performed
Service Provider Name
Service Provider Address 1
Service Provider Address 2
Service Provider Address 3
Service Provider City, State, Zip
Service Provider Telephone
Service Provider Email
Social Security No.
See IRS Form W-9
__________________________________________
Signature of service provider
Approved:
__________________________________________
Signature of supervisor or fund administrator
Name of supervisor or fund administrator
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