Application for payment (G702-style summary)
To owner
Project
From contractor
Contract date
Application no.
Period to
Architect / owner's rep
| Line | Description | Amount ($) |
|---|---|---|
| 1 | Original contract sum | |
| 2 | Net change by change orders | |
| 3 | Contract sum to date (line 1 + line 2) | |
| 4 | Total completed and stored to date (column G on the continuation sheet) | |
| 5a | Retainage on completed work ____ % | |
| 5b | Retainage on stored materials ____ % | |
| 5 | Total retainage (5a + 5b) | |
| 6 | Total earned less retainage (line 4 − line 5) | |
| 7 | Less previous certificates for payment (line 6 of the prior application) | |
| 8 | Current payment due (line 6 − line 7) | |
| 9 | Balance to finish, including retainage (line 3 − line 6) |
| Additions ($) | Deductions ($) | |
|---|---|---|
| Approved in previous months | ||
| Approved this month | ||
| Totals | ||
| Net change |
Contractor
The contractor states that the work covered by this application has been completed in accordance with the contract documents, and that amounts previously paid have been applied as the contract requires.
By
Date
Certified for payment
Amount certified ($)
Architect / owner's rep
Date
Independent template in the G702/G703 layout. AIA, G702 and G703 are trademarks of The American Institute of Architects; this is not an AIA document. Use the forms your contract requires.