Teacher Name *

First

Last

BILL TO: DANTE ALIGHIERI SOCIETY, INC. | 4050 West Maple Road, Ste #250 | Bloomfield Hills, MI 48301

Invoice Date *

Email *

Invoice # *

1-Course title and location - Indicate # of students attending *

1- Starting - Ending Date *

1- Number of sessions *

1- Number of hours *

2-Course title and location. Indicate # of students attending

2- Starting - Ending Date

2- Number of sessions

2- Number of hours

3- Course title and location. Indicate # of students attending

3- Starting - Ending Date

3- Number of sessions

3- Number of hours

Total Number of hours for group classes

Total Number of hours for private classes

Hourly Rate for group classes

Hourly Rate for private

Total Amount for group classes

Include any refund for administrative expenses if any.

Total Amount for private classes

Include any refund for administrative expenses if any.

Grand TOTAL *

Include any refund for administrative expenses if any.

Signature *

Upload any expense receipt for refund.

Click or drag a file to this area to upload.

Captcha *