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TOTAL <br /> <br />$. FI~ES <br />Al. Enter ToL~J ~ccs ~Tem ~ecLion #4 <br />A~ Add Stmc Su/ch~ge (.05% x A l ) <br /> <br />B. Enter 30% of tine Al for PIa~ Review <br />C. Invert Fcc, <br /> <br />E, A~n~ P~ Rev~w (62.50~, <br /> <br />F. ~s~ f~ which no ~ ~ ~e~ ~di~, <br /> <br /> TOT~ ~O~T DUE <br /> <br />SUBTOTAL: $ //], <br /> <br /> $ <br /> <br /> $ <br /> <br /> <br />