Construction Payment Application
Project Name
Application No.
Date
Period To
Contractor Name
Owner Name
Contract Details
Contract Amount
Change Orders
Total Value
Work Completed
Item No.
Description of Work
Scheduled Value
Work Completed This Period
Work Completed to Date
Balance to Finish
% Complete
Less Retainage (%)
Total Earned Less Retainage
Less Previous Payments
Current Payment Due
Remarks
Authorized Signature