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40 <br />0 <br />SAMPLE INVOICE <br />Date: <br />The following charges reflect your portion of the responsibility I'or the reason Im <br />expense as detailed below: <br />Nature of Charges <br />Attached is a check for $ <br />Please satisfy. <br />in the amount of $ <br />Bate incurred Amount Due <br />(member organization) <br />from the holding account which was last reported <br />to have a balance of $ on (date) <br />Authorized signature: <br />Title: <br />Joint Fiber Optics Project - Interlocal Agreement <br />Appendix B — Page 6 <br />