Independent Contractor Invoice

PO #:______________________ Banner Invoice #:______________________

Internal Distribution: ____________________________________________________

Сontractor Required for Payment

Name: ____________________________ SSN: _____________________________
Telephone/Fax: _____________________ Employer ID: ______________________
Mailing Address: ______________________________________________________
Date(s) of Service: _____________________________________________________

Date(s) of Service: Notes/Comments:

Other Ground
Fee Meals Lodging Airfare Total
Expenses Transportation

Total:

Note: First class or business flights will not be approved. Personal automobile will be
reimbursed at current IRS rates only. Expenses greater than $25 will not be paid
unless original receipts are attached.
Contractor must submit all original receipts to the hiring administrator.

___________________ ___________________ ___________________

Signature Contractor Date

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