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Fee for Service Agreement Request Form

If you have any questions about this form, contact Jennifer Tucker at 785-864-5854 or jentucker@ku.edu.

 

Your Information
xxx-xxx-xxxx
Client Information
First and last name
First and last name.
xxx-xxx-xxxx
Project Information
Account into which the funds will be deposited.
First and last name.
xxx-xxx-xxxx
Please attach a document detailing the services to be provided.
Files must be less than 2 MB.
Allowed file types: pdf doc docx.
$
%
If needed.
Report a Second Rate
$
%
Report a Third Rate
$
%
Report a Fourth Rate
$
%
Report a Fifth Rate
$
%
$
If total cost is unavailable, please estimate.
If applicable.

Additional Supporting Documents (optional)

Files must be less than 2 MB.
Allowed file types: pdf doc docx.
Files must be less than 2 MB.
Allowed file types: pdf doc docx.
Files must be less than 2 MB.
Allowed file types: pdf doc docx.
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