Agency Name

Invoice #

  • Write here



  • Write here



Mileage can only be charged in addition to a bonus if pre-approved by your Relationship Manager.

Booking ID


Caregiver Name

Client Name


State


Start Date


Actual Start Time


Actual End Time


Total Hours


$0.00


$0.00


$0.00


$0.00


Req Start Time


Req End Time


Total Hours


$0.00


$0.00


$0.00


$0.00


Hourly Rate


Bonuses


Mileage


Total Cost


$0.00


$0.00


$0.00


$0.00


Notes


CANCELLATIONS

Booking ID


> / < 24 Hours

Client Name


State


Date

Total Hours


Hourly Rate


$0.00


$0.00


$0.00


$0.00


$0.00


$0.00


Invoice Total

Cancellation Policy

1. If a job is cancelled with more than 24 hours’ notice, agencies are permitted to charge a $30 fee and should list 1.00 under the total hrs column.

2. If a job is cancelled with less than 24 hrs notice, agencies are permitted to charge up to 8 hrs at their normal hourly rate

3. If all days of a multi-day job are cancelled simultaneously, or within 15 minutes of each other, agencies are permitted to

charge us either one less than 24 hr cancellation fee or one more than 24 hrs cancellation fee, depending on when the cancellation occurred.

4. Bonuses are not paid on cancelled jobs, unless a caregiver arrives at a client's home and is then told that the job has been cancelled.

5. If a caregiver arrives at a client's home and finds out that a job has been cancelled, agencies are permitted to charge the full shift.

6. Only the columns highlighted in pink in the cancellation section need to be filled in.