Consulting Invoice Template
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1Consulting Invoice
General Information
Email or
Name
Telephone No.
Home address Line#1
Line#2
City/State/Zip
Are you a:
Yes
No
UNC-Chapel Hill employee?
State of North Carolina employee? State Agency?
Federal employee?
U.S. citizen?
(If not, include copy of passport & visa if you performed work in U.S. or traveled to U.S.)
Retiree of the State of North Carolina and receiving benefits? Retirement date
Services
Description of services rendered
Amount
$
Daily or hourly rate, if applicable $
Number of hours worked:
hrs
Period covered
through
Percentage of work performed in North Carolina
%
(Work performed in North Carolina is subject to NC income tax withholding.)
Record-keeping
I understand that I am required to provide on this form my Social Security Number (SSN) so that UNC-
Chapel Hill can satisfy its tax obligations under North Carolina and federal laws. Unless I have stricken
through this sentence and put my initials beside it, I voluntarily permit UNC-Chapel Hill to use my Social
Security Number as a personal identifier for other internal record-keeping and data processing operations
of UNC-Chapel Hill.
Social Security Number
-
-
I am not a U.S. citizen and do not have a SSN.
_____________________________________
_________
Signature
Date
Name of your contact at CPC
Form recipient
Email, FAX or mail to:
Name: Ms. Connie Padgett
Email: connie_padgett@unc.edu
Fax: 919-966-3014
Mailing address: Carolina Population Center
University Square East
123 W. Franklin St.
Chapel Hill, NC 27516
(10/08)
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Parent category: Business