CoSignCT Invoice Generator
Please submit this form immediately after your assignment is completed. All submissions will be sent to billing@cosignct.com for processing.
Email address *
Name *
Date of Service *
MM
/
DD
/
YYYY
Scheduled Duration of Service (Hours / 15 min intervals) *
Actual Duration of Service (Hours/ 15 min intervals) *
Client Name *
Consumer Initials *
Details - include description of assignment (i.e. meeting, doctor appt), service start time, location of assignment & name of academic class (if applicable): *
Was the assignment cancelled *
Required
Date of Cancellation
MM
/
DD
/
YYYY
Time of Cancellation
Time
:
Reason for Cancellation
Clear selection
Was the Assignment Teamed? *
Name of the Teamed Interpreter(s), if applicable (First Initial/Last Name):
Does any of the following apply to this assignment?
What is your hourly rate of pay? *
Enter a number only, no currency symbol or other letters
Travel Pay *
Required
Roundtrip, Portal to Portal Mileage (Please only input number of miles here, no other words or text)
PLEASE NOTE: Invoices will be paid via direct deposit bi-monthly per the CosignCT annual payment schedule provided
For additional billing and policy information visit our website (www.cosignct.com)
A copy of your responses will be emailed to the address you provided.
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