AMD‐23E Aircraft Use Report (11/14)
Contractor
Task
Order #
Invoice Start
Date
N#
Item #
Page 1
of:
Invoice End
Date
Hired Time
Hired
Date
Vendor Signature: The following record of services provided is correct
Make/
Model
PIC Pilot
Release Date
Gov Rep Signature: The following record of services provided were received
Release Time
Agency
Phone
Name
(print)
Date
Name
(print)
Date
E-Mail
NonFleet TIME Based Charges
Date
Pay Item
Code
Start
Date
Pay Item
Code
Quantity
Stop
Elapsed Time
From
To
# of PAX Cargo Payload
TAX
Mission
Code
Billee Code
Billee Agreement #
Charge Code
Fire
Billee Code
Billee Agreement #
Charge Code
Fire
NonFleet FEE Based Charges
Rate
Total
City
State
TAX
Remarks:
Page 1