Preston Bass Interpreting Services

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*Interpreter:
*Address:
*City:
*State:
*Zip code:

*Telephone #1:	Voice / Videophone / TTY / Fax
Telephone #2:	Voice / Videophone / TTY / Fax

*Email Address:

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ASSIGNMENT INFORMATION:

*Date of Assignment:
*Time Start:
*Time End:
*Location:
*Client:

Comments:

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PAYROLL INFORMATION:

*Hours worked:
*Hourly rate:
*Amount due:

*Check here indiciates that I certify that this invoice and any other information submitted here is, to my best of my knowledge and belifef, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including termination of employment with Preston Bass Interpreting Services.

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