CV-5062 REV 04/29/2013 Acctg. Proc. K.13.0
From:
Law Firm:
Address:
Phone #:
To:
ARBITRATION OFFICE: Attn: ADR Clerks 408-882-2100 X2410
Re: ARBITRATION CIVIL EARLY SETTLEMENT CONFERENCE
Invoice Amount: $150.00
Services Rendered for:
Case Name: Case#:
The hearing commenced on and took day(s)
Arbitration Award was rendered on
Case was settled on
Notice of Settlement filed on
Case did not settle.
Vendor # Claimant Signature Date Approved by
A vendor number is required to process your payment. It is located on the top left hand corner of the check
stub if you have previously been paid by the Court. If you do not have a vendor number, you must submit a W-9
form so that one can be requested. If the Court doesn't have a vendor number or W-9 form your payment will be
delayed until one is received.
(FOR ACCOUNTING USE ONLY)
GL ACCOUNT: 939102 COST CENTER: 434012 FA: 1220 FUND: 110001
DOCUMENT #:
DOCUMENT ENTERED BY & DATE:
DOCUMENT AMOUNT
$
COMMENTS:
REVIEWED BY & DATE:
PAYMENT APPROVAL & DATE:
Judicial Arbitrators & CESC Neutrals Claim Form Template
