taTME Site Invoice Submission Invoice #Primary Contact Name First Last Make Check Payable To Institution(Required) Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Email(Required) Contact Phone(Required)Standard Invoice ItemsSite Administrative Fee IRB Start-Up IRB Renewal IRB Closeout IRB Modification Fee (per modification, max 4 mods) Please calculate the total and enter it here. Subject Enrollment Fee ($750 per subject, max 10)Enrolling One New SubjectEnrolling Two New SubjectsEnrolling Three New SubjectsEnrolling Four New SubjectsEnrolling Five New SubjectsEnrolling Six New SubjectsEnrolling Seven New SubjectsEnrolling Eight New SubjectsEnrolling Nine New SubjectsEnrolling Ten New SubjectsSite Number-Subject Number Please specify the number of enrolled subjects you are invoicing for using the format Site Number-Subject Number (i.e. MSH Subject 1 = 10-01)Subject Data Mgmt. Fee (maximum) Subject Data Mgmt. Fee (maximum)Enrolling One New SubjectEnrolling Two New SubjectsEnrolling Three New SubjectsEnrolling Four New SubjectsEnrolling Five New SubjectsEnrolling Six New SubjectsEnrolling Seven New SubjectsEnrolling Eight New SubjectsEnrolling Nine New SubjectsEnrolling Ten New SubjectsSubtotal $0.00 Additional Invoice Items (Additional Subjects enrolled)Additional Item #1 Additional Item Cost #1 Additional Item #2 Additional Item Cost #2 Additional Item #3 Additional Item Cost #3 Additional Item #4 Additional Item Cost #4 Additional Item #5 Additional Item Cost #5 Subtotal $0.00 Total Upload Additional Documentation BelowAccepted file types: pdf, doc, docx, xls, xlsx, Max. file size: 600 MB.If you have your invoice and would prefer to use your own, please do so here.