2027 HSMTA Adjudicator Invoice Form
Broadway Dallas will do it's best to process all invoices in a timely manner. Adjudicators should expect to receive payment 3-4 weeks after invoice submission.
Full Name
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
How much should I invoice?
Adjudication Payment
Rows
School
Date (MM/DD/YYYY)
Rate ($)
School #1
School #2
School #3
School #4
School #5
School #6
Total Adjudication Payment Owed
Mileage Payment- adjudicators can invoice for schools 25+ miles from their starting destination.
Rows
Starting Location
Ending Location
Date (MM/DD/YYYY)
# of Miles
Tolls*
School #1
School #2
School #3
School #4
School #5
School #6
Total Mileage Payment Owed
Proof of Tolls
Browse Files
Cancel
of
Total Toll Reimbursement Owed
Total Amount Owed
Judge Signature
*
Signature (type full name):
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: