Technical Exhibit 4

ABC HOTEL

MAYBERRY, NC

CONTRACT W9124D-08-D-XXXX

EXAMPLE

MONTHLY INVOICE

MAYBERRY MEPS

1 - 31 MAY 2009

DATE OF INVOICE: 6/3/09

Description Unit Price

Army Nat'l Guard

DAG

Army Regular

DAR

Army Reserve

DAV

Air Force Guard

DFG

Air Force Regular

DFR

Air Force Reserve

DFV

Regular Marine

DMV

Marine Reserve

DMV

Navy Regular

DNR

Navy Reserve

DNV

Coast Guard Regular

GPR

Coast Guard Reserve

GPV

Technical Exhibit 4 (Revision 1) 1

Lodging Applicant $50.00 $ $ $ $ $ $ $ $ $ $ $ $

Lodging Enlisted $50.00

Walk-Ins $50.00

Emergency g y Lunches (A) $5.00 $ $ $ $ $ $ $ $ $ $ $ $

Emergency Lunches (E) $5.00

No shows (A) $50.00

No shows (E) $50.00

$No shows (E) $50.00 $ $ $ $ $ $ $ $ $ $ $ $

Technical Exhibit 4 (Revision 1) 1

SAMPLE

ABC HOTEL

MAYBERRY, NC

CONTRACT W9124D-08-D-XXXX

EXAMPLE

MONTHLY INVOICE

MAYBERRY MEPS

1 - 31 MAY 2009

DATE OF INVOICE: 6/3/09

Description Unit Price

Army Nat'l Guard

DAG

Army Regular

DAR

Army Reserve

DAV

Air Force Guard

DFG

Air Force Regular

DFR

Air Force Reserve

DFV

Regular Marine

DMV

Marine Reserve

DMV

Navy Regular

DNR

Navy Reserve

DNV

Coast Guard Regular

GPR

Coast Guard Reserve

GPV

Technical Exhibit 4 (Revision 1) 2

Total Monthly Charges $ $ $ $ $ $ $ $ $ $ $ $

TOTAL INVOICETOTAL INVOICE

AMOUNT

FOR MAY 2009: I certify this invoice to be accurate and that all services were provided in accordance with the contract

Data to be pulled from USMEPCOM Forms 727 and 728

Contractor Representative Date

Technical Exhibit 4 (Revision 1) 2

SAMPLE