#2650 @001 Enter the name of the OWNER: @002 Enter the name of the CONTRACTOR: @100 Enter name of individual to receive draw request: @101 Enter street address of OWNER: @102 Enter city, state, zip code of OWNER: @103 Enter name/number of job: @200 Enter the draw number: @104 Draw is requested for period beginning: @105 Draw is requested for period ending: !106 Enter in numerals the total draw request: @116 Enter the date of original contract: #2651/#2652/#2653 Draw was based on: per centage of completion stage of completion cost plus formula #if#2651 @117 Enter the percentage of completion: !107 Enter the total draw received to date (in numerals): !108 Enter the total present retainage (in numerals): #endif #if#2652 @109/@109/@109/@109 Enter the stage of completion: rough in first inspection final inspection KEY IN VALUE #endif #if#2653 !110 Enter total expenditure to date (in numerals): #2654 Is a architect certificate or other support attached? #if#2654 @112/@112/@112 The following is attached: architect's certificate inspection report KEY IN VALUE #endif #2655 #end control section #2650 /* Para. 2650: Draw request */ To: @001 Attention: @100 @101 @102 Dated: ____________________ Re: @103 Job Draw request number: @200 Draw request from period @104 to @105 Total amount of draw request: $ @106 (!106 dollars) Pursuant to the contract of @116, and any change orders thereto, @002 requests a total draw in the amount indicated. #2651 /* Para. 2651: Draw based upon % completion */ The present per centage completion of the project is @117 per cent. The total draws requested and paid to date equal $ @107 (!107 dollars) and $ @108(!108 dollars) is the present retainage. #2652 /* Para. 2652: Draw based on rough in/etc */ The project has reached the @109 stage. #2653 /* Para. 2653: Draw based on cost plus */ The total expenditure to date is $ @110 (!110 dollars). #2654 /* Para. 2654: Architect certificate or other infor */ A @112 is attached. #2655 Dated: ______________________ _____________________________________________ For @002, CONTRACTOR