Company Name: _______________

WATER
BILL
Name: _______________
Street Address: _______________
City, State: _______________
ZIP Code: _______________
Phone: _______________ INVOICE
E-mail: _______________

Invoice # _______________ Date: _______________

Bill to Ship to
Name: _______________ Name: _______________
Street Address: _______________ Street Address: _______________
City, State: _______________ City, State: _______________
ZIP Code: _______________ ZIP Code: _______________

Description Quantity $ / Unit Amount ($)

Comments or Special Instructions: SUBTOTAL

___________________________________________ DISCOUNT
SHIPPING
Payment is due within ____ days. TAX
TOTAL

Thank you for your business!