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FormV6 : ACTUAL DAMAGES INVOICE

 

Required entries are indicated by blue icons or *

et al (and all others)


Owner/Agent has sustained the following damages:
 
Breach of Contract:
 
Action Taken:
 
Date Action Taken:
 

Please Note: This form does not calculate totals.

Repair Cost
 
Materials
 
quantity
 X 
materials cost
 = 
sub-total
Time Incurred
 
hours/minutes
 X 
charge per hour
 = 
sub-total
Cost of Forms
 
# of forms
 X 
form cost
 = 
sub-total
Copying/Printing
 
quantity
 X 
cost
 = 
sub-total
Total Mileage
 
total miles
 X 
IRS mileage rate
 = 
sub-total
First Class Postage
 
# of stamps
 X 
cost
 = 
sub-total
TOTAL DUE
 
Due Date:
 
(30 days from Date of Notice)
 

Please Note: Signature field must be filled in and signed after printing.

Owner/Agent Signature:   Date:

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PO Box 20862, Keizer, OR 97307
eMail: office@oregonrentalhousing.com