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PAYMENT REQUEST <br /> (This form should accompany all invoices submitted for payment& be completed in its entirety) <br /> Operating Company Name: <br /> Address: <br /> Operating company: <br /> Job Name: Phone#: <br /> Job Address: Fax#: <br /> Purchase Order#: Invoice#: <br /> Invoice Date: <br /> Base Contract Amount: $ Percent Complete <br /> CO# $ Invoice Amount: $ <br /> CO# $ Less 10% Retention: $ <br /> CO# $ Subtotal: $ <br /> CO# $ Less Previous Invoiced: $ <br /> Revised Contract Amount: $ mount Due this Invoice: $ <br />