HomeMy WebLinkAbout304870 11/03/16 a o•'C,AM
J`( �'� CITY OF CARMEL, INDIANA VENDOR: 367794
. ® :j• ONE CIVIC SQUARE TAKEFORM
CHECK AMOUNT: S**'****'*48.36*
r �� CARMEL, INDIANA 46032 11601 MAPLE RIDGE ROAD CHECK NUMBER: 304870
vy,TON, � MEDINANY 14103 CHECK DATE: 11/03/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1091 4230200 56426 48.36 OFFICE SUPPLIES
Voucher No. Warrant No.
367794 Takeform Allowed 20
11601 Maple Ridge Road
Medina, NY 14103
In Sum of$
$ 48.36
ON ACCOUNT OF APPROPRIATION FOR
109 - Monon Center
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1091 56426 4230200 $ 48.36 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 _
November 1, 2016
IpAdi�94��
Signature
$ 48.36 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
Z
RECEIVED
Invoice��5G426
1601` Aa IeRld a Road
== -- 9 - O C T 14 2016 Invoice"Date - 1 b/1F0% s
800-528-1398 -PO# XX=4383
Payment Terms:&Iggf30
Bill To: Carmel Clay Parks & Recreation Ph: (317) 573-4026
Fax: (317) 571-4136
Attn: Dawn Koepper Email: dkoepper@carmelclayparks.com
1411 E. 116th Street
Carmel, IN 46032
Job Name: CAR0061: Monon Community Center
Line Description Quantity D- nit--N-etrNef
Price Price Ext
1 Type K: Name Plate w/Desk Stand 1 41.36 41.36
Net Subtotal: $41.36
Shipping and Handling: $7.00
Net Total:
BaaI nce Due (l7SD)"' x$48 36
Terms are Net 30. Past due accounts are subject to 1% interest per month. We reserve the right to hold future orders or
ship future orders COD if terms are not adhered to. Purchaser is responsible for all fees and expenses including but not
limited to, attorneys and collection fees incurred by Takeform in the enforcement of this agreement.
Credit cards accepted. Please complete form below and fax to Accounts Receivable at 585-798-8889
Payment Options: Carmel Clay Parks&Recreation
r-1VisaMasterCard Discover American Express Invoice #
Balance Due: $48.36
Cardholder's Name:
Card Number:
CVV2#:
Expiration Date:
Card Billing Address:
Signature:
Print Date:10/11/2016 6:28:41AM Page 1 of 1