[Your Business Name]

Project Information

  • Client Name:
  • Project Address:
  • Project Description:
  • Service Date(s):
  • Service Quote Total: $[Amount]

Payment Terms

  • Due Date: Payment is due in full within [number] business days of service completion.
  • Late Payment Fee: A late fee of [percentage or fixed amount] will be applied to any outstanding balance after the due date.

Payment Methods

Please select your preferred method of payment:

  • [ ] Check payable to [Your Business Name]
  • [ ] Credit Card (processed online) - A processing fee of [percentage] may apply.
  • [ ] Cash (on-site payment) - Exact change only, please.

Liability Waiver:

By signing below, you acknowledge that:

  • The services outlined in the service quotation have been completed to your satisfaction (refer to Job Completion and Acceptance Form).
  • [Your Business Name] is not liable for any pre-existing damage or hidden conditions uncovered during the project, unless caused by negligence of the company.
  • You agree to the payment terms and late fee policy outlined above.

Client Signature:


Payment Release Authorization

[Optional, for subscription plans]

For subscription plans only, I authorize [Your Business Name] to automatically deduct the monthly subscription fee of $[amount] from my [credit card/bank account] on the [date] of each month.

Client Signature:


Please Note:

  • This form serves as a record of payment authorization and release for completed services.
  • Retain a copy of this form along with the signed Job Completion and Acceptance Form for your records.
  • For any payment inquiries, please contact [Your Business Name] at [phone number] or [email address].