R4 Constructors Payment Request Form
Please fill out the form and include all required information. If you are filling out requests for multiple projects, please click on the "Submit another request" link on the confirmation page after you hit the form submit button at the bottom of the initial and subsequent  form(s). If you have any questions or comments, please contact r4constructors@gmail.com. If you would like an Excel spreadsheet to fill out instead of this online form please contact us ASAP.  Thank you.
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Your (subcontractor) Company Name *
Skilled Trade Type *
i.e. Plumbing, Electrical, Excavation, Structural Steel, Landscaping, HVAC, Paint, Flooring, Tile, etc. Please keep it general but specific to your trade. If you have any questions about what you should put, please post them in the "Other" box at the bottom of this form.
Date *
Project Name *
Original Contract Amount *
Approved Change Orders *
Change Orders signed by R4 Constructors AND the Owner
Pending Change Orders *
Potential Change Orders not yet approved by R4 Constructors or Owners
Revised Contract Amount *
Add Original Contract Amount and Approved Change Orders together to find this amount
Work Completed to Date *
Enter total work completed to date
Previous Gross Request Amount Total *
Enter the total gross requests you have submitted for this project
This Months Gross Request Amount *
Subtract Previous Gross Request Amount Total from Work Completed to Date. If this is a no retention job, enter this same number in the Net Request Amount
Retention Amount *
Enter 5% of the Gross Request Amount in this box. If this is a no retention project, enter "0"
Net Request Amount *
Subtract the Retention Amount from the Gross Request Amount
Invoice Number
Other
Contact Email *
Please Enter the Contact Email for the person filling out this form
Submit
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