Sample Invoice Cover Letter

(MUST USE AGENCY’S OFFICIAL LETTERHEAD)

(Date)

(Contract Manger’s Name)

Maternal, Child and Adolescent Health Program

Allocation and Matched Funding Unit

1615 Capitol Avenue, MS 8305

P.O. Box 997420

Sacramento, CA 95899-7420

MATERNAL, CHILD AND ADOLESCENT HEALTH AGREEMENT # 000000 –

(AGENCY NAME)

Enclosed for payment is our (Quarterly/Monthly) invoice number #00 for the

(MCAH/BIH/AFLP) Program in the amount of $(Invoice Amount), which covers the

period beginning (Date) and ending (Date) for services rendered pursuant to the

terms and conditions established in the above referenced MCAH Allocation

Agreement.

Note that any deviations from the last approved budget need to be addressed in

detail within this paragraph.

As required by the MCAH Allocation Agreement, an electronic version of this invoice

has also been sent. Should you have any questions regarding this invoice payment

request, please contact (Contact Name), (Contact Title), at (Contact Phone Number)

or by e-mail at (Contact E-Mail Address).

Sincerely,

(Original Signature)

(Title of Signer)

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Sample Invoice Cover Letter

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