Free Parent Education Invoice for Security Guard SCA-FC-PE-6606 - West Virginia

Parent Education Invoice for

SECURITY GUARD
SECURITY GUARD'S PAYMENT INFORMATION
Security Guard: _______________________________________________ Make check payable to: _____________________________________________ Address for remittance: _____________________________________________ _____________________________________________

Send completed form to: Pepper Flenner WV Supreme Court of Appeals 1900 Kanawha Blvd. E., Building 1, Room E-100 Charleston, WV 25305

Phone (home):__________________________ Phone (work):_______________________ Fax:________________________ E-mail address:__________________________________________ Payee's Social Security Number or F.E.I.N. (Whichever applicable): ______________________________________

Class information (ONE class per invoice form)
Date _______________ County where held ___________________Class taught by :___________________________________

Number of hours worked

___________

X

$ 20.00

Multiply hours worked by hourly rate

Total Amount Due $______________

Signature (Must be in blue ink)_____________________________________________________________ Date_____________________

Administrative office use only:

Approved: ________________________________________________________________

Date:___________________

SCA-FC-PE- 606 12/13/06