Invoice Form - Autism Funding Branch
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1INVOICE
Invoice Date
Invoice Number
Service Provider Name:_____________________________________________
Mailing Address:___________________________________________________
City:______________________________________Postal Code:____________
Phone Number:(
)
-_______________
If payee is different from above complete this section
Payee Name:_____________________________________________
Mailing Address:___________________________________________________
City:______________________________________Postal Code:____________
Phone Number:(
)
-_______________
Bill To:
Autism Funding Branch
Ministry of Children and Family Development
PO Box 9776 STN PROV GOVT
Victoria BC V8W 9S5
Billing Number:
________________________________________________
Client Name (Child): ________________________________________________
Month Service Provided:
Type of Service
Dates
# of
Rate Per Hour
Total
inclusive of PST if applicable
Hours
Amount
$
$
TOTAL SERVICES
$
TOTAL GST / HST
$
TOTAL INVOICE AMOUNT
$
_____________________________
______________________________
Service Provider Signature
Parent Signature
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Parent category: Business