Invoice

Environmental Mediation Center - Mediator Invoice Form

This invoice form applies to all 3 programs (VTAMP, HIAMP, and NHAMP)



Mediation Details / Payments

In Hours
In Hours
In Hours
$
Prep and Mediator time bill at $180/hour with $60/hour donation = $120/hour paid
$
Miles * $.50/mile

Mediator Information

By typing your name above and submitting this form you certify the above invoice is accurate.
Sending