1. 10 Steps to fill out application for payment.
For Hunt’s Taylor Creek Contractor’s, Inc.

2. Application for payment
APPLICATION NO:
APPLICATION DATE:
TO GENERAL CONTRACTOR:
PROJECT:
PERIOD TO:
Hunt's Taylor Creek Contractors, Inc.
PROJECT NO:
12074 S 141st Street E
CONTRACT FOR:
CONTRACT DATE:
Gore, OK
FROM CONTRACTOR: Name
Address:
____________________________________
CONTRACTORS APPLICATION FOR PAYMENT
Application is made for payment, as shown in connection with the Contract.
Continuation Sheet is attached. 1
ORIGINAL CONTRACT SUM 2
Net change by Change Orders 3
CONTRACT SUM TO DATE (Line 1 & 2)
$0.00 4
TOTAL COMPLETED AND STORED TO DATE (Column G on Continuation Sheet)
0.00 5
RETAINAGE a. 10
% of Completed Work
(Column D+E on Continuation Sheet) b.
% of Stored Materials
(Column F on Continuation Sheet)
Total Retainage (Lines 5a + 5b or Total in Column I of
Continuation Sheet) 6
TOTAL EARNED LESS RETAINAGE 7
LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificates) 8
CURRENT PAYMENT DUE
(Line 3 less line 6)
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
The undersigned Contractor certifies that to the best of the
Total changes approve in
Contractor's knowledge, information and belief the work covered
previous months by owner
by this Application for Payment has been completed in accordance
Total approved his month
with the Contract Documents, that all amount have been paid by
TOTALS
the Contrctor for Work which previous Cerfificates for Payment
NET CHANGES by Change Order
were issued and payments received from the Owner, and that
current payment shown herein is now due
Contractor:
By:________________________________________________
Date:______________________________
State of_________________________ County of___________________________ Subscribed and sworn to before me this _____________
day of Notary Public:____________________________________
My Commission expires________________

3. Step 1
Fill in the project name, the project number, and who the contract is for.

4. Step 2
Fill out application number, and application date. (For example, if this is your first pay application for a specific project, then you would put a 1 next to application number)

5. Step 3
Put the 15th of the month as the day that you are billing through.
DO NOT BILL AHEAD.
The date that you signed the contract needs to be put next to Contract Date.

6. Step 4
Write the name of your company, and your company’s address.

7. Step 5
Fill in the amount that is on your original contract in the first box.
Fill in the total amount of your approved change orders to date in the second box.
Then press enter, and it will automatically fill in the correct amount in the third box.

8. Step 6
On the Breakdown sheet, Columns A, B, and C, put the exact Cost Code, Description, and Scheduled Value that is found on your contract. WE WILL NOT ACCEPT IT UNLESS THIS INFORMATION IS TAKEN DIRECTLY FROM YOUR CONTRACT.

9. Step 7
Complete Column D, E, and F on the Breakdown sheet, and it will automatically fill in the correct amounts on columns G-I and also lines 4, 5a, 5b, total retainage, 6, 7 and 8 on the 1st page.

10. Step 8
Follow directions in this table.

11. Step 9
Sign and date the pay application. Then have it notarized.

12. Step 10
The deadline for turning in each pay application is the 15th of every month. If the 15th falls on a weekend, then it is due the Friday before.
Send in pay applications to and You can also send it to our fax at