ELC Membership Fee Invoice Voucher

	A	B	C	D	E	G	H	I	J	K	L	M	N
1								AGENCY USE ONLY
2								AGENCY NO.			LOCATION CODE		P.R. OR AUTH. NO.
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5		AGENCY NAME
6				[College Info Here]
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9								Certificate. I herby certify under penalty of perjury that the items and totals listed herein are accuratefor materials, mer- chandise or services furnished to the State of Washington, and that all goods furnished and / or services rendered have been provided without discrimination on the grounds of race, creed, color, national origin, sex, or age.
10		VENDOR OR CLAIMANT (Warrant is to be payable to)
11		WA ELC c/o OLYMPIC COLLEGE
12		CASHIER'S OFFICE
13		1600 CHESTER AVE
14		BREMERTON WA 98337
15								BY
16									(SIGN IN INK)
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18								(TITLE					(DATE)
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20	FEDERAL I.D. NO. OR SOCIAL SECURITY NO. (For Reporting Personal Services Contract Payments to I.R.S.)
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22	DATE		DESCRIPTION							UNIT(S)	UNIT PRICE	AMOUNT	FOR AGENCY USE
23			eLearning Council Annual Fee, 2024-2025							1	$400	$400
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34	Carrier			Shipping Document No.		Collect	Prepaid		No. Pieces		Received By		Date Received
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36	ACCOUNT CODE											AMOUNT
37	FUND	APPROP.	PROGRAM		OBJECT							LIQUIDATION	NET INVOICE
38	840		286		90015								$400
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43	TOTAL												$400
44	CHECKED AND APPROVED FOR PAYMENT BY:			INVOICE DATE	INVOICE NO.	GROSS INV. AMT.		DISCOUNT IN $		NET INV. AMT.		VOUCHER NO.	WARRANT NO.
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46	-73-											F:/Common/Image98/A19 Invoice Voucher GG 1/01
47		Credit card payments also accepted - pay by cc.
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