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REFUND DUE PtECEIVEp INVOICE <br /> ELK CREEK COMPANIES DATE: 8/25/2021 <br /> SEP 0 7 2021 INVOICE # STATEMENT <br /> Customer ID DRMS 02 <br /> PO Box 416 DIVISION OF RECLAMATION <br /> Conifer CO 80433 MINING&SAFETY <br /> Phone: <br /> email: maldonadojuliet2l@gmail <br /> • SHIP TO (if different): <br /> Colorado Division of Reclamation [Name] <br /> Division of Natural Resources [Company Name] <br /> 1313 Sherman St [Stress Address] <br /> Denver CO 80203 [City, ST ZIP] <br /> [Phone] [Phone] <br /> SALESPERSONP.O. # SHIP DATE SHIP VIA F.O.B. TERMS <br /> 8/11/2020 Due Upon Receipt <br /> DESCRIPTION <br /> • • • • <br /> INV 12-301 REFUND Exploration and Prospecting Fee 1 2,000.00 2,000.00 <br /> Admin Admin charges 1 323.00 323.00 <br /> I in <br /> n"', ofyrq <br /> LATE FEE Monthly Late Fees 12 150.00 1,800.00 <br /> SUBTOTAL $ 4,123.00 <br /> Other Comments or Special Instructions TAX RATE 0.000% <br /> 1. Total payment due upon receipt TAX $ - <br /> 2. Please include the invoice number on your check S & H $ <br /> OTHER $ - <br /> 4. Late fees/Costs will accrue at terms indicated in contract TOTAL $ 4,123.00 <br /> 5. Parties non-responsive/no show to 2 scheduled inspection date <br /> copies of correspondance attached Make all checks payable to <br /> ELK CREEK DIVERSIFIED <br /> If you have any questions about this invoice, please contact <br /> Juliet Moores 303 931 6858 <br /> Thank You For Your Business! <br /> ©2008 Vertex42 LLC Invoice Templates by Vertex42.com <br />