Work Order Request Form

Because your time is more valuable than money.

THE PERMIT SPECIALIST, LLC

ITEMIZED Work order

__________________________________________________

Date: ________________

Company/Contractor Name:_________________________

Contact Name: ___________________________________

Phone#: ________________________________________

Fax#: __________________________________________

Deliver To: (Name/Address/City-State/Zip)

Bill To: (Name/Address/City-State/Zip)

Invoice No. #: ___________

Permit Expediting Services Requested For:

INVOICE TYPE:

¨ PROPOSAL

¨ PARTIAL/RETAINER NOW DUE/FINAL BALANCE PENDING

¨ FINAL (REMIT WITHIN 3 DAYS, THANK YOU)

¨ REIMBURSEMENT RECEIPT ATTACHED

Thank You For Your Business!

MAIL PAYMENTS TO:

P. O. BOX 94064

ATLANTA, GA 30377

This website is an original copyright and is the domain of The Permit Specialist, LLC. ©2004, 2005, 2006, 2007, 2008, 2009, 2010. All Rights Reserved. Any duplication is strictly prohibited. If copied, you will be reported for

Type of Construction: R-Residential C-Commercial O-Other	County Or City Municipality	Lot #	Subdivision Name or Project Name	Project Address	Type of Work: N—New R– Renovation A—Addition C—Correction S—Specialty RV-Revision	Sewer or *Septic Disposal 0r Revision Date	Fee:$







						Subtotal $
						(Misc.)
						Qty: _____
						Total Due $
						Payment $
						Balance Due$
Make checks payable to: THE PERMIT SPECIALIST, LLC *This invoice constitutes an agreement of contract terms. A $40.00 fee will be charged for each returned check for insufficient funds which have presented for payment. All fees and all outstanding invoice balances will be due payable in CASH immediately.

Date of Contract:	Vendor No.#:	Invoiced Date:	Amt. Due TPS:	Deliver Date:	Payment Status:	Form of Payment:	Invoice Closed
					¨ Partial ¨Pd In Full	CASH/ CHECK/ CC