Month Day, Year

Please make payment to: (9 Pt Georgia Italic)

School, College, or Division (12 Pt Georgia Regular)

Department (9 Pt Georgia Regular)

Building Number or Building Name (9 Pt Georgia Regular)

Street Number, Street Name

City, State ZIP

For billing and other account questions, please contact First Last at 000-000-0000 or email@uga.edu.

Invoice #: 00000 (12 Pt Georgia Bold)

Billed to: (9 Pt Georgia Italic)

First Last (12 Pt Georgia Regular)

Building Number or Building Name

Street Number, Street Name

City, State ZIP

Description (9 Pt Georgia Bold)	Unit Price	Quantity	Total

TOTAL: $00.00 (18 Pt)

Please complete and return by email for intra-university payments:

UGA Account Name:	Account Name

UGA Account Number:	#######	Object Code:	ABCD1234