Submit Inv | GRC Homecare

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INDEPENDENT CONTRACTOR'S INVOICE

BILLED TO: GRC HOMECARE PROVIDER

BILLED BY

First name*

Last name*

Phone*

Address*

SERVICES INFORMATION

CLIENT'S FULL NAME*

CLIENT'S ADDRESS*

SERVICE TYPE

HOURLY

LIVE-IN

RATE PER HOUR OR DAY*

START DATE & TIME

END DATE & TIME

# OF HOURS / DAYS

BILLED AMOUNT

0

TOTAL HOURS BILLED:*

GRAND TOTAL BILLED:*

This is to certify that all of the data shown above are true and correct and the Independent Contractor performed his/her duty outstandingly and to the satisfaction of the Client for the agreed sum of the billed amount.

SIGNATURE*

Date*

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