GENERAL CONTRACTOR CONSTRUCTION INVOICE SAMPLE TEMPLATE

Blank Application for Payment can be found on page 2.

APPLICATION FOR PAYMENT
APPLICATION NUMBER
TO OWNER	PROJECT
PERIOD ENDING
CONTRACT WORK
FROM CONTRACTOR
CONTRACT NO
PREPARED BY
CONTRACTOR'S APPLICATION FOR PAYMENT	CONTRACTOR'S CERTIFICATION
Refer to backup sheets attached for detailed breakdown	The undersigned Contractor to the best of his knowledge, information and believe of the Work covered by this Application for Payment has been completed in accordance with the Contract Documents, that all amounts have been paid to him for Work for which previous Certificates for Payment were issues and payments received from the Owner, and that current payment shown herein is now due.
1	Original Contract Amount:	$20,000.00
2	Net Changes to Contract:	$600.00
3	Total Contract Amount:	$20,600.00	CONTRACTOR	DATE
4	Total Completed To Date:	$15,000.00
5	Retainage:	State	Country
a.	15%	of Completed Work	Subscribed & sworn to before me
Total Retainage:	$2,250.00	this	day of
6	Total Completed Less Retainage:	$12,750.00	Notary Public Name	Commission Expiration Date
7	Less Previous Applications:	$5,000.00
ENGINEER'S CERTIFICATE FOR PAYMENT
8	Current Payment Due:	$7,750.00	The Engineer hereby confirms that based on site observations & to the best of his/her knowledge, this payment application accurately reflects the progression of work and that this work meets contract requirements sufficient enough to justify payment in the amount certified below:
9	Balance to Finish Including Retainage:	$7,850.00
AMOUNT CERTIFIED
EXTRA WORK SUMMARY	ADDITIONS	DELETIONS	Provide explanation below or attached if amount certified does not match this application amount. Initial all figures & markups to agree with certified amount.
Changes From Previous Applications	$1,000.00	$400.00
Changes From This Application	$0.00	$0.00	ENGINEER	DATE
Total	$1,000.00	$400.00	The Amount Certified is payable to the contractor listed above.
Net Changes	$600.00

APPLICATION FOR PAYMENT
APPLICATION NUMBER
TO OWNER	PROJECT
PERIOD ENDING
CONTRACT WORK
FROM CONTRACTOR
CONTRACT NO
PREPARED BY
CONTRACTOR'S APPLICATION FOR PAYMENT	CONTRACTOR'S CERTIFICATION
Refer to backup sheets attached for detailed breakdown	The undersigned Contractor to the best of his knowledge, information and believe of the Work covered by this Application for Payment has been completed in accordance with the Contract Documents, that all amounts have been paid to him for Work for which previous Certificates for Payment were issues and payments received from the Owner, and that current payment shown herein is now due.
1	Original Contract Amount:
2	Net Changes to Contract:
3	Total Contract Amount:	CONTRACTOR	DATE
4	Total Completed To Date:
5	Retainage:	State	Country
a.	of Completed Work	Subscribed & sworn to before me
Total Retainage:	this	day of
6	Total Completed Less Retainage:	Notary Public Name	Commission Expiration Date
7	Less Previous Applications:
ENGINEER'S CERTIFICATE FOR PAYMENT
8	Current Payment Due:	The Engineer hereby confirms that based on site observations & to the best of his/her knowledge, this payment application accurately reflects the progression of work and that this work meets contract requirements sufficient enough to justify payment in the amount certified below:
9	Balance to Finish Including Retainage:
AMOUNT CERTIFIED
EXTRA WORK SUMMARY	ADDITIONS	DELETIONS	Provide explanation below or attached if amount certified does not match this application amount. Initial all figures & markups to agree with certified amount.
Changes From Previous Applications
Changes From This Application	ENGINEER	DATE
Total	The Amount Certified is payable to the contractor listed above.
Net Changes

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