HIRED PERSON LOG Name * First Name Last Name Date of job * MM DD YYYY Company Name * Location #1 Donor(s) Location #2 Donor(s) Location #3 Donor(s) Location #4 Donor(s) Buisness Expense Payment method * (PMLT) - BUSINESS CARD OWNER PERSONAL CARD MY PERSONAL CARD/ACCOUNT (NEED REIMBURSEMENT) Rental Car cost (If applicable) Gas cost (If applicable) Uber/Lyft/Taxi cost (If applicable) Other payment Details or expenses: Amount owed to you * PAYMENT PREFERENCE Cash App Zelle Check Other Other payment preference (If applicable) Provide payment preference link or where to send request * SUPPLY RESTOCK? * No Chain of custodies Urine cups Pens Sharpies Gloves Trash bags Blue dye Hand sanitizer Fed Ex Labels Fed Ex bags other other, if applicable After submitting this form, you will receive an agreement for you to sign and your payment will be sent within 48 hours. * I Agree Fed-Ex Tracking # Did you drop specimen at FedEx? * Yes, it has been dropped off No, working on that Doesn't apply Thank you!