Free Construction Payment Request Form Template
Construction Payment Request Form
Please fill out this form to request payment for work completed or materials provided on the construction project.
Contractor Name
Company Name
Please provide your email address.
Phone Number
Project Name
Name of the Construction Project
Project Location Address
Date of Request
Invoice Number
Invoice Number for Tracking
Payment Breakdown
|
Expense Category |
Amount ($) |
Notes |
|---|---|---|
|
Labor Costs |
|
|
|
Materials Costs |
|
|
|
Equipment Costs |
|
|
|
Subcontractor Costs |
|
|
|
Other Costs |
|
|
|
Total Amount Due |
|
Payment Terms
Payment Due Date
Payment Method
-
Check
-
Bank Transfer
-
Bank Account Details (if applicable)
Bank Name
Account Number
Routing Number
Project Completion Details (if applicable)
Percentage of Work Completed
Indicate the percentage of the completed work.
Milestone Achieved
Describe the milestone achieved.
Additional Notes or Comments
Provide any additional information regarding this payment request, such as pending approvals or payment justifications.
Inspection Approved By (if applicable)
Name:
Date:
Submitted By
Name:
Date:
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