HomeMy WebLinkAbout235578 08/06/14 1�d.Gpgyf CITY OF CARMEL, INDIANA VENDOR: 368518
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ONE CIVIC SQUARE CULLIGAN WATER OF BOONE COUNTY CHECK AMOUNT: $*****1,168.95*
CARMEL, INDIANA 46032 PO BOX 797 CHECK NUMBER: 235578
ATTN: ACCTS RECEIVABLE CHECK DATE: 08/06/14
LEBANON IN 46052
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4350100 6314 1,168.95 BUILDING REPAIRS & MA
l
Dear Valued Customer,
This check was received in error at our location in Waseca, MN.
Culligan Water
1104 S State St
Waseca,MN 56093-3145
Thank you!
OA&4"%W-
U
batter water.pure and simple:
PREVIOUS BALANCE:. $0.00
DATE QUANTITY DESCRIPTION REF AMOUNT BALANCE
06/18/2014 1.00 RO COMMERCIAL SALE 839.00 839.00
06/18/2014 1.00 EVERPURE INSURICE COMM SALE 329.95 1168.95
ACCOUNTS ARE SUBJECT TO A LATE PAYMENT FINANCE CHARGE
FINANCE CHARGE SCHEDULE PLEASEPAYNEW
OVER PERIODIC RATE ANNUAL RATE BALANCE BEFORE
s _ 1. 15% '1.u ) JUL 25, Balance Due $1168. 95
TO Il,Il jl% (1,i1�� %IMIN
CHARGE .Ilil
i-ail sl-6G 90 Next Deliveries:.
116�.P5 ,1,ill) Qil
Colli-fan c.f E:•_one County
P-) 7C,7
Lebanon, Ill lr,f15._
(7F5) 4x'.-'-57ii (317 _877.:
SERVICE ADDRESS: _
CAFTIEL FIFE DEPT STATIUII #41
JII'I SPELBRI1,IG STATEMENT DATE ACCOUNT NUMBER NAME
RHF<L1ELIII �I u�i3_LS41Ur.F:E
CiiEL li 3ni2014 11373: CARI=IEL FIRE DEPT STATIC)11 041
113738
000"�a
'Znvoke 6314jUNE 18,201E
Culligan Water Conditioning of Boone County
PO Box 797
1328 W Main St
Lebanon, IN 46052
765-482-2570 317-873-8772
boonecullianC�mymetronet.net
To: Ship to (if different address):
CARMEL FIRE DEPARTMENT STATION #41
)IM SPELBRING
2 CIVIC SQUARE
CARMEL IN 46032
Quantity Description Unit price Amount
1 AQUA CLEER 50GPD W/10GAL TANK 839.00
1 EVERPURE INSURICE 2000 329.95
1 INSTALLATION INCLUDED
Subtotal 1168.95
Sales Tax EXEMPT
Total Daae $1168.95
Please detach Portion below (cut at line) and send with your remittance.
D CHECK HERE IF CHANGE OF ADDRESS
Account Number: 113738 If you have any questions regarding this
Amount Due: $1168.95 bill, please contact:
Amount Enclosed: 765-482-2570
Mail Payment to. 317-873-8772
Culligan Water of Boone County booneculligan@mymetronet.net
PO Box 797
Lebanon, IN 46052
Attn: Accounts Receivable Thank You For Your Business!
Or pay online at: www.culligancentralindiana.com
® CUSTOMER ORDER DATE
ORDER ACCOUNT#
MARKETING SOURCE:
❑SAME AS SERVICE ADDRESS
NAME - NAME
ADDRESS -_ ADDRESS
CITY STATE ZIP CITY— STATE- ZIP--,---COUNTY
COUNTY CONTACT NAME: •• s
CROSS STREETS/LOCATION_—_ __---_ BILLING TERMS ❑BFMONTHLY ®QUARTERLY ❑SEWTANNUALLY
HOME# WORK#____ p®�ry ANNUALLY �❑-y AUTOMATIC MONTHLY BILLING
w PAYMENT METHOD LJ CASH D DEBIT El CREDIT CARD ❑FINANCING
EMAIL EMPLOYER
DRIVERS LICENSE# BANK—__ BRANCH
BANK ACCOUNT# _—_ ❑SAVINt3S ❑CHECKING
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{- CREDIT CAPD EXPIRATION^x,E
❑ PRNAT€HOME ❑
APARTMENTCD COMMERCIAL OCCUPANTS__..._..._ —
❑' MUNICIPAL SUPPLY ❑ PRIVATE WELL PSI RANGE _.- to
IMITIAI SIGN UP FEE $ ❑ 1N5FECT10,v FEE S —❑ PRICE
FLOW RATE gpm ESTIMATE WATER USAGE go!.pet TRANSFER Fi -11GITAL OF ALL THA_#APPLY
j__
ALKALINITY_--TDS NITRATES TURBIDITY
ANNUAL PAYMENT 5_——_ _-_❑ INITIALS -
IRON SULPHUR_ PH_._ _ _HARDNESS gp9 TAX °6 EKEMPTiON
OTHER_-- — - ._-�_ TOTAL BALANCE OWING #�
timi;c+ia.�r`Jcna:ions to your_*sU^ply fram the car--ve p
ara}ysis mny 0"""_ e Pe;fo-r:a::e o :i:is tgaipmsnt. CUSTOM KNOWS THAT SPECIAL iNSTRUCTIONS _
Adjcs`;+en.'s and/or adc Foal equipne^i my ee reauired. HOSf$I$15 SOT,
t'r�ss Mri�Ee gruv+de3 atter o:e•mikng rates.
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prrRCt R.CE
1 QTY. P1;ODEL I
DESCRIPTION t DESCRIPTION t yr SE2tA1# PURCHASE DAITE P!
t
iNSTALLARON CHARGE ( ?
TOTAL INITIAL RENTAL CHARGE I
SALT DELVIERY ❑YES ❑NO SALT lbs.@ 3 per
( I DATE _ ❑.="r+. ❑PM
PURCHASE OTHER
I CALL ❑DAY of ❑DAY BEFORE PHONE
PURCHASE OTHER
RE-LEST SCHEDULE DATE
RENTAL OTHER j y
RENTAL O'T`TER j ADDITIONAL COt RENTS:
DELIVERY FEE
` BOTTLE DEPOSIT/CREDIT F
SECU'RITf DEPOSIT — —
OTHER You,the buyer, may cancel this transaction at any time
prior to midnight of the third business day rafter the
TAX - date of this transaction. Sea: the attached notice of
TOTAL cancellation form for an explanaticin of this right.
LESS RECEIVED WITH ORDER El CASH [3 CHECK ❑CREDIT CARO ' Customer's signature
BALANCE DUE Print name -- Dote
Representative _ Rep Code
This order subject to Terms and conditions stated
on reverse side.Culligan dealerships are Dealership approval
independently operated.
J
VOUCHER NO: WARRANT NO.
ALLOWED 20
Culligan
IN SUM OF$
PO Box 797
Lebanon, IN 4.6052 -- ----- -- --
$1,168.95
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
:10#/Dept. INVOICENO. ACCT#rrITLE AMOUNT Board Members
1120 6314 43-501.00 $1,168.95 1 hereby certify that the attached invoice(s), or
bill(s) is(are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
JUL 4 2014
,. �._. .
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
i
i
VOUCHER NO. WARRANT NO.
ALLOWED 20
Culligan
IN SUM OF $
PO Box 797
Lebanon, IN 46062 -- ------- --------
$1,168.95
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 6314 43-501.00 $1,168.95 1 hereby certify that the attached invoiceI(s), or
bill(s) is (are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
JUL 14 2014
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
I
Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service,where performed, dates service rendered, by
whom, !tales her day, nun tbcr of hours, rate per hour, 11111111)er 01 units, price per unit, etc.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoices) or bill(s))
6314 $1,168.95
I hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
, 20
Clerk-Treasurer