HomeMy WebLinkAbout303757 09/30/16 a p�.Cggy
a`! CITY OF CARMEL, INDIANA VENDOR: 364573
ONE CIVIC SQUARE PLYMATE CHECK AMOUNT: $******"877.02*
r. CARMEL, INDIANA 46032 819 ELSTON DRIVE CHECK NUMBER: 303757
9M,.,._ .o. SHELBYVILLE IN 46176 CHECK DATE: 09/30/16
t «OX�
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 R4356001 32943 2613273 43.82 UNIFORMS
601 5023990 2613668 146.82 OTHER EXPENSES
1205 R4356001 32943 2614846 43.82 UNIFORMS
651 5023990 2614907 249.29 OTHER EXPENSES
601 5023990 2615237 146.82 OTHER EXPENSES
1205 4350600 2615830 246.45 CLEANING SERVICES
VOUCHER# 162828 WARRANT# ALLOWED
364573 IN SUM OF $
PLYMATE
819 ELSTON DR
SHELBYVILLE, IN 46176
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
2615237 01-6360-06 1146.822
Voucher Total
Cost distribution ledger classification if
claim paid under vehicle highway fund
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
364573
PLYMATE Purchase Order No.
819 ELSTON DR Terms
SHELBYVILLE, IN 46176 Due Date 9/26/2016
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
9/26/2016 2615237 146.82
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
Date Officer.
CITY OF CARMEL WATER DIST Invoice# 2613668 '
3450 W 131 ST ST (800)553-2661
WESTFIELD, IN 46074 Date 09/15/2016 � �_ www.plymate.com
Cust# 2934 819 Elston Drive
Stop 470 P11.1111 � � Shelbyville, IN 46176
Jerry Smith Vkrkplace Apparel&Floor Plat Programs
RT 12
Linea #. ask Name/:Description ., Repi Set'':U,, a� s 3
1 SHOP TOWEL RED 100 $6.00
3 1 EDDIE ALVAREZ $8.21
5 GARMENT CARE 22 $1,32
. _. ---- -- ..... - ................- --- ...... ..._...- ------.-m._-.........-----.._.. ... _. _ ......_.---
6 4 JUSTIN BRANDT $7.45
8 GARMENT CARE 22 $1.32
9 7 ALEX BROWN $7.45
11 GARMENT CARE 22 $1.32
12 14 STEVE CALLAHAN $7.25
15 GARMENT CARE 22 $1.32
16 9 ALDWIN CASTANEDA $7.45
19 GARMENT CARE 22 $1.32
_...._... . .....--- ........_......... ...._. - _... ..._ _.. ------ ------ .__. ......_ ... ........ ...... ---.. ......_......
,
20 15 STEVE COOK $3.66
22 GARMENT CARE 11 $0.66
23 11 SHAWN COOKSEY $7.45
25 GARMENT CARE 22 $1.32
26 2 FRAZIER JONES $8.21
28 GARMENT CARE 22 $1.32
29 10 MIKE LUPER $8.20
32 GARMENT CARE 22 $1.32
33 3 MATT MCNULTY $8.21
35 GARMENT CARE 22 $1.32
36 6 JOE MERCER $7.45
38 GARMENT CARE 22 $1.32
39 13 TRENT MORGAN $9.70
43 GARMENT CARE 22 $1.32
.........._.. -
44 12 JERRY SMITH $4.55
46 GARMENT CARE 11 $0.66
47 5 BARRY THOMAS $9.70
49 GARMENT CARE 22 $1.32
50 8 SEAN WHITLOW $7.45
52 GARMENT CARE 22 $1.32
Service Charge $9.95
Page 1 of 2
CITY OF CARMEL WATER DIST Invoice# 2613668
3450 W 131 ST ST (800)553-2661
WESTFIELD, IN 46074 Date 09/15/2016 ,
Cust# 2934 ' www•Plymate.com
1 ! t �
819 Elston Drive
Stop 470 Shelbyville, IN 46176
Jerry Smith Vk)rkplace Apparel&Floor Mat Programs
RT 12
Line # NarnelDescription,, Iriv Qt Rental ` ReptlRep[:
Subtotal $146.82 ;V&4 e A40 WOW
Tax r -
1 -^
Total 146.82
Thanks for your business.
Your Service Rep-zea Vw
i
Past Due Amounts
30 Days 60 Days 90 Days Customer Signature
$ 0.00 $ 0.00 $ 0.00 RT 12
�I
Page 2 of 2
CITY OF CARMEL WATER DIST Invoice# 2615237
1
3450 W 131 ST STDate 09/22/2016 0 (800)553-2661
WESTFIELD, IN 46074 Cust# 2934 www.plymate.com
819 Elston Drive
Stop 470 P- "Y'M Shelbyville, IN 46176
Jerry Smith Vbrkplace Apparel&Floor Mat,Programs
RT 12
'
Description
Re 4
1 SHOP TOWEL RED 100 $6.00
3 1 EDDIE ALVAREZ $8.21
5 GARMENT CARE 22 $1.32
...........
6 4 JUSTIN BRANDT $7.45
8 GARMENT CARE 22 $1.32
9 7 ALEX BROWN $7.45
11 GARMENT CARE 22 $1.32
12 14 STEVE CALLAHAN $7.25
. ................................ ....................................... ............................ -----........................... ...........
15 GARMENT CARE 22 $1.32
16 9 ALDWIN CASTANEDA $7.45
19 GARMENT CARE 22 $1.32
20 15 STEVE COOK $3.66
22 GARMENT CARE 11 $0.66
23 11 SHAWN COOKSEY $7.45
25 GARMENT CARE 22 $1.32
26 2 FRAZIER JONES $8.21
............................
28 GARMENT CARE 22 $1.32
29 10 MIKE LUPER $8.20
32 GARMENT CARE 22 $1.32
...............
33 3 MATT MCNULTY $8.21
35 GARMENT CARE 22 $1.32
36 6 JOE MERCER $7.45
38 GARMENT CARE 22 $1.32
39 13 TRENT MORGAN $9.70
43 GARMENT CARE 22 $1.32
44 12 JERRY SMITH $4.55
46 GARMENT CARE 11 $0.66
47 5 BARRY THOMAS $9.70
49 GARMENT CARE 22 $1.32
50 8 SEAN WHITLOW $7.45
52 GARMENT CARE 22 $1.32
Service Charge $9.95
Page 1 of 2
CITY KDFCARMEL WATER DIST Invoice# 2615237
345OVV131ST8T Date Dg��2O10 (800)553-2661VVESTF|ELD. |N46O74 Nr wwvplymataoom
Cuot# 2934
u�ys|oton�hve
�V � �'��
Stop 47O ���n���� -�'Shelbyville,
-'- 1rU
Jerry Smith
Urkplace Apparel&Floor Mat Programs
RT 12
Subtotal $146.82
Tax
Total 8146J8
Thanks for your business.
Your Service Rap-%�ute em?.
Past Due Amounts
-301]ays 60 Days 9K0I&ays_ Customer Signature
$ U0O � 0D0 � 0UO
� ' � RT 12
Page 2 of 2
VOUCHER # 166221 WARRANT # ALLOWED
364573 IN SUM OF $
PLYMATE
819 ELSTON DRIVE
SHELBYVILLE, IN 46176
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
2614907 01-7360-02 71.94
2614907 01-7362-05 53.35 N 9
2614907 01-7362-06 124.00
Voucher Total 249.29
Cost distribution ledger classification if
claim paid under vehicle highway fund
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
364573
PLYMATE Purchase Order No.
819 ELSTON DRIVE Terms
SHELBYVILLE, IN 46176 Due Date 9/21/2016
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
9/21/2016 2614907 249.29
hereby certify that the attached invoice(s), or bill(s) is (are)true and
:orrect and I have audited same in accordance with IC 5-11-10-1.6
Date Officer
CITY OF CARMEL UTIITIES Invoice# 2614907
9609 HAZEL DELL PKWY Date 09/21/2016 (800)553-2661
INDIANAPOLIS, IN 46240as1 ±°:r www.plymate.com
Cust# 2256 FAL .1059.- 819 Elston Drive
Stop 150 !�lymate j C: gas
.n Shelbyville, IN 46176
v
JeffCooper %brkplace,Apparel&Floor Mat Programs
RT 17
ine Manr'W'"Ifein# Namel Desc r tion;;,:'. Sizes., Amount, Inv. Qt
Subtotal $249.29 i �sid cctuacce
Tax
Total $249.2
Thanks for your business.
Your Service Rep-?Daae Lax
Past Due Amounts I � �
30 Days 60 Days 90 Days Customer Signature
$ 0.00 $ 0.00 $ 0.00 RT 17
qq
S 3 3S
Page 3 of 3
CITY OF CARMEL UTIITIES Invoice# 2614907 r "v" (800)553-2661
9609 HAZEL DELL PKWY Date 09/21/2016
INDIANAPOLIS, IN 46240 www.plymate.com
Cust# 2256tte 819 Elston Drive
Stop 150 Shelbyville, IN 46176
Jeff Cooper ftrkrlace Apparel&Floor Mat Frogfams
IRT 17
Inv.I Oty'::
Sizes Amodht� 2,
N' �Nscriotio6","
1 290 MICRO RIBBED TERRY TO $20,80 100 40 40 40 40 40 25
2 290 MICRO RIBBED TERRY TO $2.84 100 2
3 476 SHOP TOWEL RED $18.72 300 50 50 50 50 50 50
4 476 SHOP TOWEL RED $8.55 300 15
5 477 SHOP TOWEL WHITE $24.96 300 50 50 50
6 477 SHOP TOWEL WHITE $8.55 300 15
8 5 6937 MICAH BECK PANT RK UTILITY JEAN 3230 $3.66 11
9 INSPGM GARMENT CARE GARMENT CARE 11 $0.66
10 22 6937 PETER BRENNAN PANT RK UTILITY JEAN 3234 $3.66 11
11 INSPGM GARMENT CARE GARMENT CARE 11 $0.66
12 25 6937 KEVIN BUHMANN PANT RK UTILITY JEAN 4430 $4.39 11 2 1 2 2 3 2
13 25 6610S KEVIN BUHMANN SHIRT KH BLACK SS MICROCHE 2X 00 $3.83 11
14 INSPGM GARMENT CARE GARMENT CARE 22 $1.32
15 31 6925 TYLER CALLAHAN PANT DENIM JEAN 4032 $3.15 11
16 INSPGM GARMENT CARE GARMENT CARE 11 $0.66
17 13 6925 BART CHAFIN PANT DENIM JEAN 3230 $3.15 11
18 INSPGM GARMENT CARE GARMENT CARE 11 $0.66
19 16 6925 CALVIN COOPER PANT DENIM JEAN 3834 $3.15 11
20 INSPGM GARMENT CARE GARMENT CARE 11 $0.66
21 18 6925 JEFF COOPER PANT DENIM JEAN 3830 $3.15 11 4 5 4 4 4 5
22 INSPGM GARMENT CARE GARMENT CARE 11 $0.66
23, 501 6863 DAVE DYE LAB COAT WHITE 3X RG $4.88 11 1 4 2 2 4
24 INSPGM GARMENT CARE GARMENT CARE 11 $0.66
25 14 6925 LARRY EIDSON PANT DENIM JEAN 4032 $3.15 11
26 14 6610S LARRY EIDSON SHIRT KH BLACK SS MICROCHE 3X OT $4.47 11
27 INSPGM GARMENT CARE GARMENT CARE 22 $1.32
28 15 6925 GREG EPP PANT DENIM JEAN 3230 $3.15 11
29 INSPGM GARMENT CARE GARMENT CARE 11 $0.66
30 32 6937 GUADALUPE ESPARZA PANT RK UTILITY JEAN 3628 $3.66 11 4 5 5 2 4 5
31 32 6610S GUADALUPE ESPARZA SHIRT KH BLACK SS MICROCHE LG 00 $3.19 11 3 1 4 1 2 2
32 INSPGM GARMENT CARE GARMENT CARE 22 $1.32
33 3 6863 FRANK GRANNAN LAB COAT WHITE 46 RG $4.07 11 1 2
34 3 6937 FRANK GRANNAN PANT RK UTILITY JEAN 3432 $3.66 11 4
35 INSPGM GARMENT CARE GARMENT CARE 22 $1.32
36 17 6925 TONY HARVEY PANT DENIM JEAN 3634 $3.15 11 4 5 4 2 4 4
37 INSPGM GARMENT CARE GARMENT CARE 11 $0.66
38 2 6925 BRAD HAYMAKER PANT DENIM JEAN 3832 $3.15 11
39 INSPGM GARMENT CARE GARMENT CARE 11 - $0.66
40 27 6937 DUANE JARVIS PANT RK UTILITY JEAN 3830 $3.66 11 3 4 5 1 3 3
41 27 6610L DUANE JARVIS SHIRT KH BLACK LS MICROCHE IX RG 1
Page of 3
CITY OF CARMEL UTIITIES Invoice# 2614907
9609 HAZEL DELL PKWY Date 09/21/2016 (800)553-2661
INDIANAPOLIS, IN 46240Cust# 2256 www.plymate.com
$e,
P°ilymatel,:a4 819 Elston Drive
Stop 150 Shelbyville,IN 46176
Jeff Cooper Urkrilac?Apparel&Floor Mat Programs
RT 17
ine .Man '''Item# Name"/TD'escn Amount°I Inv Cit °;:1., 2
42 27 6610S DUANE JARVIS SHIRT KH BLACK SS MICROCHE 1X 00 $1.39 4 3 1 1
43 INSPGM GARMENT CARE GARMENT CARE 16 $0.96
44 26 6937 ROBBIE KINKEAD PANT RK UTILITY JEAN 3830 $4.32 11 1 4 1 2 2
45 INSPGM GARMENT CARE GARMENT CARE 11 $0.66
46 28 6937 MATT LAFOLLETTE PANT RK UTILITY JEAN 3430 $3.66 11
47 28 6610S MATT LAFOLLETTE SHIRT KH BLACK SS MICROCHE LG 00 $3.19 11
48 INSPGM GARMENT CARE GARMENT CARE 22 $1.32
49 12 6925 CURT MANIFOLD PANT DENIM JEAN, 4030 $3.15 11 2 1 1 2
50 INSPGM GARMENT CARE GARMENT CARE 11 $0.66
51 21 6925 GARY MERRILL PANT DENIM JEAN 3432 $3.15 11
52 21 6610S GARY MERRILL SHIRT KH BLACK SS MICROCHE 1X 00 $3.83 11
53 INSPGM GARMENT CARE GARMENT CARE 22 $1.32
54 1 6937 BRAD OLIVER PANT RK UTILITY JEAN 3630 $3.66 11 1 1 5 3 2 4
55 INSPGM GARMENT CARE GARMENT CARE 11 $0.66
56 24 6937 LONNIE PATTON PANT RK UTILITY JEAN 3634 $3.66 11
57 INSPGM GARMENT CARE GARMENT CARE 11 $0.66
58 23 6937 ERIC ROBINSON PANT RK UTILITY JEAN 3232 $3.66 11 3
59 INSPGM GARMENT CARE GARMENT CARE 11 $0.66
60 30 6937 KYLE SMITH PANT RK UTILITY JEAN 3830 $3.66 11
61 INSPGM GARMENT CARE GARMENT CARE 11 $0.66
62 8 6937 JASON STEWART PANT RK UTILITY JEAN 3634 $3.66 11
63 INSPGM GARMENT CARE GARMENT CARE 11 $0.66
64 29 6937 JEFF TRAGESSER PANT RK UTILITY JEAN 3634 $3.66 11
65 29 6610L JEFF TRAGESSER SHIRT KH BLACK LS MICROCHE 1X LN 6
66 29 6610S JEFF TRAGESSER SHIRT KH BLACK SS MICROCHE 1X 00 $1.74 5
67 INSPGM GARMENT CARE GARMENT CARE 22 $1.32
68 7 6937 DAVID TURNER PANT RK UTILITY JEAN 3630 $3.66 11 4 5 4 5 5 5
69 INSPGM GARMENT CARE GARMENT CARE 11 $0.66
70 4 6937 MIKE TURNER PANT RK UTILITY JEAN 3232 $3.66 11 3 3 3 5 2 5
71 INSPGM GARMENT CARE GARMENT CARE 11 $0.66
72 500 6863 TARA WASHINGTON LAB COAT WHITE LG RG $1.48 4 2 1
73 500 7705 TARA WASHINGTON SCRUB SHIRT-CIEL BLUE MD RG $3.55 11
74 500 7710 TARA WASHINGTON SCRUB PANT-CIEL BLUE MD RG $3.55 11
75 INSPGM GARMENT CARE GARMENT CARE 26 $1.56
Service Charge $9.95
Page 2 of 3
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
PLYMATE ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
819 ELST,ON DRIVE IN SUM OF$ CITY OF CARMEL
An invoice or bill to be property itemized must show:kind of service,where performed,dates service
SHELBYVILLE, IN 46176 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
$246.45 Payee
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
General Administration Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
2615830 43-506.00 $246.45 1 hereby certify that the attached invoice(s),or 9/27/16 2615830 $246.45
1205 101 1205 101
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
Wednesday, September 28,2016
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
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
CARMEL CITY HALL Invoice# 2815830 �� PMatMan
ONE CIVIC SQUARE Date 09/27/2016 <800X553-2661
CARMEL, |N4S032 Cuot# 7073 FAII&
wwwp�m��nom
A
819sL8TONoR
Stop 500 :�������� =� O*sLsYv|LLs. |w*V17O
JEFF BARNES &brkpmmApp nel&Rmr&atPmgramo
Written authorization required from the City RT 30
ofCarmel tooha i frequency
1 1025 4X6 COMFORT FLOW MAT 3 $41.61
z 1088 4XOLOGO MAT 1 $18.87
3 1074 4xOM8HGNYBRVvNMAT 5 *45.08
* 1097 ROTATE 4xsCOM FLOW
5 1208 5X15 CUSTOM MAT $41.91
u 1505 7aX7sCUSTOM MAT u $53.53
7 1506 7X1OCUSTOM MAT 1 $40.15
Service Charge *9.95
Subtotal $246.45
Tax
Total $246.4�
Thanks for your business.
YourK8otMen'R&»a*d S&Wm**
Past Due Amounts
30 Days 60Days1901}ays_ Customer Signature
$ 0OO � ODO � ODO
� � � RT 30
VOUCHER NO. WARRANT NO. Prescribed by state Board of Accounts City Form No.201(Rev.1995)
PLYMATE ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
819 ELSTON DRIVE IN SUM OF$ CITY OF CARMEL
An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
SHELBYVILLE, IN 46176 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
$87.64 Payee
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
General Administration Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
32943 2613273 43-560.01 $43.82 1 hereby certify that the attached invoice(s),or 9/14/16 2613273 $43.82
1205 Encrunbered 101 1205 101
32943 2614846 43-560.01 $43.82 bill(s)is(are)true and correct and that the 9/21/16 2614846 $43.82
1205 Encu»ebe,•ed 101 materials or services itemized thereon for 1205 101
which charge is made were ordered and
received except
Monday,September 26,2016
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
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
CARMEL CITY HALL Invoice# 2613273
ONE CIVIC SQUARE (800)553-2661
CARMEL, IN 46032 Date 09/14/2016 ,��x3
, ����,� www.plymate.com
Cust# 2787 A&
' 819 Elston Drive
630 Plymats _
PO# 32943 P Shelbyville, IN 46176
Sto
Jeff Barnes Iftliplare Apparel&Floor Ilat Programs
RT 12
",
2 2 6227 JEFF BARNES POLO RYL/BLACK SNAGPROOF 4X 00 $3.35 5
3 2 6816 JEFF BARNES PANT NAVY CARGO 4430 $6.00 13
4 2 6848 JEFF BARNES JACKET NAVY LS TEAM 4X RG $1.16 1
5 2 6919 JEFF BARNES PANT NAVY CARGO SHORTS 4411 $2.31 5
6 2 6504S JEFF BARNES SHIRT BL GR SS MICROCHEC 4X OT $3.23 6
7 2 6740S JEFF BARNES SHIRT LT BLUE SS EXEC 19500 $1.03 2
8 1 6227 CLAYTON BELL POLO RYUBLACK SNAGPROOF 3X 00 $2.87 5
9 1 6816 CLAYTON BELL PANT NAVY CARGO 4032 $5.00 13
10 1 6848 CLAYTON BELL JACKET NAVY LS TEAM 3X LN $1.00 1
11 1 6919 CLAYTON BELL PANT NAVY CARGO SHORTS 4011 $1.92 5
12 1 6504S CLAYTON BELL SHIRT BL GR SS MICROCHEC 3X OT $6.00 13
Service Charge $9.95 //���",���
Subtotal $43.82 P� #—em ek;j-6wo4
Tax
Total $43.82
Thanks for your business. Building Maintenance
Account # PO -25-/3
Your Service Rep-%ewe V4%,?. Department # I zo ,S'-
Past
"Past Due Amounts
30 Days 60 Days 90 Days Customer Signature
$ 0.00 $ 0.00 $ 0.00 RT 12
Fmitted To
SEP 2 6 2016
8 r,,QaSurer
CARMEL CITY HALL Invoice# 2614846
ONE CIVIC SQUARE Date 09/21/2018 (800)553-2661
CARMEL, |N4GU32 � mw°p�m��uum
Cust# 2787
O1yElston Drive
pf alt
pO# 32043
Stop O30 Shelbyville, |N4O17e
Jeff Barnes
Vbrkplace Apparel&8mnfhbtPrograms
RT 12
�Linej 10
2 u 6227 JEFF BARNES POLORYuBLAcK SwAGpnoor 4X 00 $3.35 u
u u 0816 JEFF BARNES PANT NAVY CARGO 4480 $6.00 13
4 z e848 JEFF BARNES JACKET NAVY LaTEAM 4X RG *1.16 1
s 2 e91e JEFF BARNES PANT NAVY CARGO SHORTS 4411 $2.31 s
6 2 6504O JEFF BARNES SHIRT oLGnGGM|CRoC*s8 4X OT $3.23 e
7 'u 6740S JEFF BARNES SHIRT LTBLUE GSEXEC 19500 . $1.08 u
8 1 6227 CLAYTON BELL POLO RYUoLACK8wAGPROOF 3X 00 $2.e7 u
o 1 6816 CLAYTON BELL PANT NAVY CARGO 4032 **.00 13
10 1 6848 CLAYTON BELL JACKET NAVY LGTEAM 3X LN $1.00 1
11 1 ee19 CLAYTON BELL PANT NAVY CARGO SHORTS 4011 $1.92 5
12 1 650*3 CLAYTON BELL SHIRT BLGnOaM|omOCMEC 3X OT $6.00 13
GumiooCxurge $yys
Subtotal �$43.82
Tax
Total $43.8�
Thanks for your business.
Your Service Rep-%we VWm
Past Due Amounts
�}DDays }UDays— Customer Signature
$ 0.00 $ 0.O0 $ O.OU RT 12