Construction Draw Payment Application

Project & Lender Information

Project Name Property Address Borrower Lender Application Date Draw Number

Draw Amount Summary

Description	Amount
Contract Amount
Prior Payments
This Draw
Retainage
Total Completed
Balance to Finish

Schedule of Values

Cost Code	Description	Scheduled Value	Work Completed - Previous	Work Completed - This Period	Total Completed	Balance to Finish	Retainage

Contractor Certification

Contractor Name Title Date Signature