INVOICE COVER LETTER

(Contract Manger's Name)
Maternal, Child and Adolescent Health Division
Allocation and Matched Funding Section
P.O. Box 997420, MS 8305
Sacramento, CA 95899-7420

MATERNAL, CHILD AND ADOLESCENT HEALTH AGREEMENT # 000000 - (AGENCY NAME)

Enclosed for payment is our (Quarterly/Monthly) invoice number #00 for the (MCAH/BIH/AFLP) Program in the amount of $(Invoice Amount), which covers the period beginning (Date) and ending (Date) for services rendered pursuant to the terms and conditions established in the above referenced MCAH Allocation Agreement.

Note that any deviations from the last approved budget need to be addressed in detail within this paragraph.

As required by the MCAH Allocation Agreement, an electronic version of this invoice has also been sent. Should you have any questions regarding this invoice payment request, please contact (Contact Name), (Contact Title), at (Contact Phone Number) or by e-mail at (Contact E-Mail Address).