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SAMPLE INVOICE <br />The following charges reflect your portion of the responsibility for the reason for <br />expense as detailed below: <br />Nature of Charees <br />Attached is a check for $ <br />Date incurred Amount Due <br />Please satisfy (member organization) <br />in the amount of $ from the holding account which was last reported <br />to have a balance of $ <br />Authorized signature: <br />Title: <br />on (date) <br />Joint Fiber Optics Project - Interlocal Agreement <br />Appendix B — Page 6 <br />