NVLAP Laboratory Assessment

and Related Services Invoice

+--------------+-------+-------------+-----+--------+---+--------------+
| Contractor:  |       |             |     |        |   |              |
|              |       |             |     |        |   |              |
+--------------+-------+-------------+-----+--------+---+--------------+
| Address:     |       |             |     |        |   |              |
|              |       |             |     |        |   |              |
+--------------+-------+-------------+-----+--------+---+--------------+
| City:        |       |             |     | State: |   | Zip:         |
|              |       |             |     |        |   |              |
+--------------+-------+-------------+-----+--------+---+--------------+
| Foreign:     |       |             |     |        |   |              |
|              |       |             |     |        |   |              |
+--------------+-------+-------------+-----+--------+---+--------------+
|              |       |             |     |        |   |              |
+--------------+-------+-------------+-----+--------+---+--------------+
| **TOTAL      |       |             | Da  |        |   |              |
| BILLED:      |       |             | te: |        |   |              |
| \$     **    |       |             |     |        |   |              |
|              |       |             |     |        |   |              |
+--------------+-------+-------------+-----+--------+---+--------------+
| Purchase     |       |             | L   |        |   |              |
| Order #:     |       |             | ine |        |   |              |
| SB1341-    - |       |             | I   |        |   |              |
|    -         |       |             | tem |        |   |              |
|              |       |             | No. |        |   |              |
| (insert last |       |             | (if |        |   |              |
| 8 characters |       |             | app |        |   |              |
| of P.O. #)   |       |             | lic |        |   |              |
|              |       |             | abl |        |   |              |
|              |       |             | e): |        |   |              |
|              |       |             |     |        |   |              |
|              |       |             |     |        |   |              |
+--------------+-------+-------------+-----+--------+---+--------------+
| Vendor       |       |             |     |        |   |              |
| Invoice No.: |       |             |     |        |   |              |
|              |       |             |     |        |   |              |
+--------------+-------+-------------+-----+--------+---+--------------+
|              |       |             |     |        |   |              |
+--------------+-------+-------------+-----+--------+---+--------------+
| **Type of    |       |             |     |        |   |              |
| Service:**   |       |             |     |        |   |              |
+--------------+-------+-------------+-----+--------+---+--------------+
| On-Site      |       | Lab Code:   |     |        |   |              |
| Assessment   |       |             |     |        |   |              |
+--------------+-------+-------------+-----+--------+---+--------------+
|              |       | Location:   |     |        |   |              |
|              |       |             |     |        |   |              |
+--------------+-------+-------------+-----+--------+---+--------------+
|              |       | Date(s) of  |     |        |   |              |
|              |       | On-Site     |     |        |   |              |
|              |       | Assessment: |     |        |   |              |
|              |       |             |     |        |   |              |
+--------------+-------+-------------+-----+--------+---+--------------+
| Evaluation   |       |             |     |        |   |              |
+--------------+-------+-------------+-----+--------+---+--------------+
| Other        |       |             |     |        |   |              |
| (specifiy):  |       |             |     |        |   |              |
|              |       |             |     |        |   |              |
+--------------+-------+-------------+-----+--------+---+--------------+
|              |       |             |     |        |   |              |
+--------------+-------+-------------+-----+--------+---+--------------+
| To expedite  |       |             |     |        |   |              |
| processing   |       |             |     |        |   |              |
| of the       |       |             |     |        |   |              |
| invoice, do  |       |             |     |        |   |              |
| **not** send |       |             |     |        |   |              |
| the invoice  |       |             |     |        |   |              |
| to NVLAP.    |       |             |     |        |   |              |
| Submit the   |       |             |     |        |   |              |
| invoice to   |       |             |     |        |   |              |
| NIST         |       |             |     |        |   |              |
| Accounts     |       |             |     |        |   |              |
| Payable      |       |             |     |        |   |              |
| using one of |       |             |     |        |   |              |
| the          |       |             |     |        |   |              |
| following    |       |             |     |        |   |              |
| methods:     |       |             |     |        |   |              |
+--------------+-------+-------------+-----+--------+---+--------------+
| By Mail to:  |       |             |     |        |   |              |
| National     |       |             |     |        |   |              |
| Institute of |       |             |     |        |   |              |
| Standards    |       |             |     |        |   |              |
| and          |       |             |     |        |   |              |
| Technology   |       |             |     |        |   |              |
|              |       |             |     |        |   |              |
| Accounts     |       |             |     |        |   |              |
| P            |       |             |     |        |   |              |
| ayable/NVLAP |       |             |     |        |   |              |
|              |       |             |     |        |   |              |
| 100 Bureau   |       |             |     |        |   |              |
| Drive, Stop  |       |             |     |        |   |              |
| 1621         |       |             |     |        |   |              |
|              |       |             |     |        |   |              |
| G            |       |             |     |        |   |              |
| aithersburg, |       |             |     |        |   |              |
| MD           |       |             |     |        |   |              |
| 20899-1621   |       |             |     |        |   |              |
+--------------+-------+-------------+-----+--------+---+--------------+
| By Fax to:   |       |             |     |        |   |              |
| 301-975-8283 |       |             |     |        |   |              |
+--------------+-------+-------------+-----+--------+---+--------------+
| By E-Mail    |       |             |     |        |   |              |
| to:          |       |             |     |        |   |              |
| invo         |       |             |     |        |   |              |
| ice@nist.gov |       |             |     |        |   |              |
+--------------+-------+-------------+-----+--------+---+--------------+
|              |       |             |     |        |   |              |
+--------------+-------+-------------+-----+--------+---+--------------+
| I certify    |       |             |     |        |   |              |
| that the     |       |             |     |        |   |              |
| above claim  |       |             |     |        |   |              |
| is in        |       |             |     |        |   |              |
| accordance   |       |             |     |        |   |              |
| with the     |       |             |     |        |   |              |
| terms of the |       |             |     |        |   |              |
| Purchase     |       |             |     |        |   |              |
| Order        |       |             |     |        |   |              |
| referenced   |       |             |     |        |   |              |
| above.       |       |             |     |        |   |              |
+--------------+-------+-------------+-----+--------+---+--------------+
|              |       |             |     |        |   |              |
+--------------+-------+-------------+-----+--------+---+--------------+
| Signature    |       |             |     |        |   |              |
+--------------+-------+-------------+-----+--------+---+--------------+
|              |       |             |     |        |   |              |
+--------------+-------+-------------+-----+--------+---+--------------+

Rev. 2006-11-27