Intake Form | Hollingsworth Consulting

Hollingsworth Consulting Intake Form

Please provide the following information below, and we will begin our Government Payment Resolution process:

Company Name: *

Primary Contact Name: *

Primary Contact Email: *

Primary Contact Phone: *

Contract Number: *

Agency/Department: *

Contracting Officer Name (if known):

Invoice Number(s): *

Invoice Amount(s): *

Date Invoice Submitted: *

Payment System Used: *

WAWF
IPP
PIEE
SAM.gov

Has the Invoice been rejected? (Yes/No) *

If rejected, what reason was given?

Has the product/service been delivered and accepted? (Yes/No): *

Receiving Report Submitted? (Yes/No): *

Any communication with the contracting office regarding payment?: *

Estimated total payment currently owed: *

Attach the following documents if available: Contract, Purchase Order, Invoice, Delivery Receipt, Payment System Confirmation