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305144 11/14/16
CITY OF CARMEL, INDIANA VENDOR: 366510 a ® , ONE CIVIC SQUARE FLEETPRIDE CHECK AMOUNT: $"""4,701.47' CARMEL, INDIANA 46032 PO BOX 847118 CHECK NUMBER: 305144 ydTON�° DALLAS TX 75284-7118 CHECK DATE: 11/14/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 2201 4237000 52078045 -350.00 REPAIR PARTS 2201 4237000 52216262 -47.28 REPAIR PARTS 2201 4237000 57958931 106.92 REPAIR PARTS 2201 4237000 80806919 109.73 REPAIR PARTS 2201 4237000 80931010 4,320.36 REPAIR PARTS 2201 4237000 80950372 272.26 REPAIR PARTS 2201 4237000 80981845 289.48 REPAIR PARTS VOUCHER NO. WARRANT NO. Prescribed by state Board of Accounts City Form No.201 (Rev.1995) FLEETPRIDE ALLOWED 20 ACCOUNTS PAYABLE VOUCHER P O BOX 847118 IN SUM OF$ CITY OF CARMEL An invoice or bill to be properly itemized must show:kind of service,where performed,dates service DALLAS, TX 75284-7118 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. $109.73 Payee Purchase Order# ON ACCOUNT OF APPROPRIATION FOR Street Department 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 80723183 42-370.00 $109.73 1 hereby certify that the attached invoice(s),or 10/24/16 80723183 $109.73 2201 201 2201 201 80806919 42-370.00 $0.00 bill(s)is(are)true and correct and that the 10/27/16 80806919 $0.00 2201 1 201 1 materials or services itemized thereon for 2201 1 201 which charge is made were ordered and received except Tuesday, November 01,2016 Dave Huffman Director 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 REMIT FlectPrideINVOICE FEETPRDOE. PO BOX 847118 TRUCK& TRAILER PARTS 80806919 DALLAS TX 75284-7118 (361) 883-4358 EXT 4000 WWW.FLEETPRIDE.COM INDIANAPOLIS IN 1140 S WEST ST (317) 632-4487 STORE NO. SHIP LOC. INVOICE TYPE QUOTE INVOICE DATE INVOICE NUMBER 352 1 IND I CHARGE SALE 1 10/27/16 1 80806919 SOLD TO CARMEL STREET DEPT. SHIP TO CARMEL STREET DEPT. 3400 W 131ST ST CARMEL IN 46074-8267 3400 W 131ST ST (317)-733-2001 WESTFIELD IN 46074-8267 CHECK NO. SHIPPER NAME ORIG. INVOICE NO. FREIGHT BILL OF LADING TERMS DELIVERED NET 30 PURCHASE ORDER NO. REQUISITION/JOB NUMBER ORDERED BY ACCOUNT SALESMAN MIKE 302461 356 UANTITY MFG. PART NUMBER DESCRIPTION UNIT PRICE AMOUNT ORD. SHIPPED CODE 2 0 20 GC3036LCW COMB.BRAKE CHAMBER-3036, 144.74 .00 WELDED CLEVIS (EA) B/O 2 20 GC3036LCW ** NEW BACKORDER ** 2 0 20 40020231 S-ABA KIT (EA) 98.60 .00 B/0 2 20 40020231 ** NEW BACKORDER ** 35 0 2700 A3264S227 DUST SHIELD (EA) 100.14 .00 B/0 35 2700 A3264S227 ** NEW BACKORDER ** INVOICE ' TOTAL $ .00 Parts & Service Freight Taxes $.00 $.00 $.00 F1eetPride makes NO WARRANTY OF MERCHANTABILITY with respect to any goods sold. There are no warranties which extend beyond the description of any goods sold on the invoice describing them. It is expressly agreed that Applicant s sole remedy for breach of any warranty with respect to goods or work is limited to the money actually received by FLEETPRIDE for the goods or work; the remedy of consequential damages is expressly excluded. It is agreed that payment of the cash price is due within the terms stated above. A SERVICE CHARGE OF I.5% per month (18% PER ANNUM) shall be due upon the amount of any charge which has not been paid when due. PLEASE PAY FROM THIS INVOICE. CORES MUST BE RETURNED WITHIN 60 DAYS TO BE ELIGIBLE FOR CREDIT. 348 IND IND_SAVE MBAUER 10/27/16 16.13.04 All Claims and returned goods MUST be accompanied by this bill. Page 1 Of 1 RECEIVED BY m REMIT TO: FlootPride INVOICE FLEETPRIDE PO BOX 847118 .TRUCK& TRAILER PARTS 80723183 DALLAS TX 75284-7118 (361) 883-4358 EXT 4000 WWW.FLEETPRIDE.COM INDIANAPOLIS IN 1140 S WEST ST (317) 632-4487 STORE NO. SHIP LOC. INVOICE TYPE QUOTE INVOICE DATE INVOICE NUMBER 352 IND CHARGE SALE 10/24/16 80723183 SOLD TO CARMEL STREET DEPT. SHIP TO CARMEL STREET DEPT. 3400 W 131ST ST CARMEL IN 46074-8267 3400 W 131ST ST (317)-733-2001 WESTFIELD IN 46074-8267 CHECK NO. SHIPPER NAME ORIG. INVOICE N0. FREIGHT BILL OF LADING TERMS DELIVERED NET 30 PURCHASE ORDER NO. REQUISITION/JOB NUMBER ORDERED BY ACCOUNT SALESMAN MIKE 302461 356 UANTITY MFG. PART NUMBER DESCRIPTION UNIT PRICE AMOUNT ORD. SHIPPED CODE 1 1 2700 A3264S227 DUST SHIELD (EA) 100.14 100.14 1 1 INBOUND FREIGHT IN-BOUND FREIGHT 9.59 9.59 INVOICE TOTAL $ 109.73 Parts & Service Freight Taxes $100.14 $9.59 $.00 FleetPride makes NO WARRANTY OF MERCHANTABILITY with respect to any goods sold. There are no warranties which extend beyond the description of any goods sold on the invoice describing them. It is expressly agreed that Applicant s sole remedy for breach of any warranty with respect to goods or work is limited to the money actually received by FLEETPRIDE for the goods or work; the remedy of consequential damages is expressly excluded. It is agreed that payment of the cash price is due within the terms stated above. A SERVICE CHARGE OF 1.5% per month (18% PER ANNUM) shall be due upon the amount of any charge which has not been paid when due. PLEASE PAY FROM THIS INVOICE. CORES MUST BE RETURNED WITHIN 60 DAYS TO BE ELIGIBLE FOR CREDIT. 348 IND IND_SAVE MBAUER 10/26/16 16.21.40 All Claims and returned goods MUST be accompanied by this bill. Page 1 Of 1 RECEIVED BY DROP SHIPMENT ** DROP SHIPMENT ** DROP SHIPMENT ** DROP-SHIPMENT ** DROP? SHIP FlectAride® CUSTOMER ORDER "I TRUCK a TRAILER PARTS ***IB T*** PACKING SLIP ENTER DATE: 10/24/16 12501690 PRINT DATE: 10/24/16 SHIP DATE: 10/24/16 FROM: TO: LNS IND 4501 S CREYTS RD CARMEL STREET DEPT ATT MIKE 3400 W 131ST ST LANSING MI 48917-8595 WESTFIELD IN 46074-8267 PHONE: (517),322-2343 PHONE: (317) 632-4487 **SHIP TO** 302461 CARMEL STREET DEPT. 80712670 356 BAUER,MARK UPS DIRECT TO CUSTOMER ........... .......................... ...�i.....R ASA,A + R11P 7CI{J� ...... I<Tf)aR .:..:...: #L1'...:: 1 A3264S227 1 1 2700 DUST SHIELD Carrier: UPS Tracking: 1ZX066000300150242 Weight: 6 Total#of Items:0 PRINT DATE: 10/24/16 12:14:35 DMILLER3 Total#of Lines on IBT: 1 PAGE 1 OF 1 PICKED BY: CHECKED BY: PACKED BY: IRTPAVIC VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995) FLEETPRIDE ALLOWED 20 ACCOUNTS PAYABLE VOUCHER P O BOX 847118 IN SUM OF$ CITY OF CARMEL An invoice or bill to be properly itemized must show:kind of service,where performed,dates service DALLAS, TX 75284-7118 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. $4,591.74 Payee ON ACCOUNT OF APPROPRIATION FOR Purchase Order# Street Department 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 52078045 42-370.00 ($350.00) 1 hereby certify that the attached invoice(s),or 1/23/13 52078045 ($350.00) 2201 201 Prior Year 2201 201 52216262 42-370.00 ($47.28) bill(s)is(are)true and correct and that the 1/30/13 52216262 ($47.28 2201 201 Prior Year materials or services itemized thereon for 2201 201 57958931 42-370.00 $106.92 12/4/13 57958931 $106.92 2201 201 Prior Year which charge is made were ordered and 2201 201 80931010 42-370.00 $4,320.36 received except 11/2/16 80931010 $4,320.36 2201 201 2201 201 80950372 42-370.00 $272.26 11/3/16 80950372 $272.26 2201 201 2201 201 80981845 42-370.00 $289.48 11/4/16 80981845 $289.48 2201 201 2201 201 Tuesday, November 08,2016 Dave Huffman Director 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 20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer m REMIT TO: FlootPrido CREDIT MEMO FLEETPRIDE PO BOX 847118 TRUCK& TRAILER PARTS 52078045 DALLAS TX 75284-7118 (361) 883-4358 EXT 4000 WWW.FLEETPRIDE.COM INDIANAPOLIS IN 1140 S WEST ST (317) 632-4487 STORE NO. SHIP LOC. INVOICE TYPE QUOTE INVOICE DATE INVOICE NUMBER 352 1 IND CREDIT MEMO L 01/23/13 [ 52078045 SOLD TO CARMEL STREET DEPT. SHIP TO CARMEL STREET DEPT. 3400 W 131ST ST 3400 W 131ST ST CARMEL IN 46074-8267 WESTFIELD IN 46074-8267 (317)-733-2001 CHECK NO. SHIPPER NAME ORIG. INVOICE NO.1 FREIGHT BILL OF LADING TERMS WILL CALL NET 30 PURCHASE ORDER NO. REQUISITION/JOB NUMBER ORDERED BY ACCOUNT SALESMAN CREDIT 302461 353 QUANTITY MFG. PART NUMBER DESCRIPTION UNIT PRICE AMOUNT ORD. SHIPPED CODE (1) (1) 931 GROUP9C-9C CORE- AD-IS AIR DRYER (EA) 350.00 (350.00) CREDIT DO NOT PAY ($350.00) Parts & Service Freight Taxes ($350.00) $.00 $.00 F1eetPride makes NO WARRANTY OF MERCHANTABILITY with respect to any goods sold. There are no warranties which extend beyond the description of any goods sold on the invoice describing them. It is expressly agreed that Applicant s sole remedy for breach of any warranty with respect to goods or work is limited to the money actually received by FLEETPRIDE for the goods or work; the remedy of consequential damages is expressly excluded. It is agreed that payment of the cash price is due within the terms stated above. A SERVICE CHARGE OF 1.5% per month (18% PER ANNUM) shall be due upon the amount of any charge which has not been paid when due. PLEASE PAY FROM THIS INVOICE. CORES MUST BE RETURNED WITHIN 60 DAYS TO BE ELIGIBLE FOR CREDIT. 348 IND CCI_Lll PARMENDARI 11/02/16 16.04.25 All Claims and returned goods MUST be accompanied by this bill. Page 1 Of 1 RECEIVED BY oetFrido0 REMIT TO CREDIT MEMO FLEETPRIDE PO BOX 847118 TRUCK& TRAILER PARTS 52216262 DALLAS TX 75284-7118 (361) 883-4358 EXT 4000 WWW.FLEETPRIDE.COM INDIANAPOLIS IN 1140 S WEST ST (317) 632-4487 STORE NO. SHIP LOC. E INVOICE TYPE QUOTE INVOICE DATE INVOICE NUMBER 352 IND CREDIT MEMO 01/30/13 [ 52216262 SOLD TO CARMEL STREET DEPT. SHIP TO CARMEL STREET DEPT. 3400 W 131ST ST CARMEL IN 46074-8267 3400 W 131ST ST (317)-733-2001 WESTFIELD IN 46074-8267 CHECK NO. SHIPPER NAME ORIG. INVOICE NO. FREIGHTBILL OF LADING TERMS WILL CALL NET 30 PURCHASE ORDER NO. REQUISITION/JOB NUMBER ORDERED BY ACCOUNT SALESMAN CREDIT 302461 353 UANTITY MFG. PART NUMBER DESCRIPTION UNIT PRICE AMOUNT ORD. SHIPPED CODE (24) (24) 5 E-5902 CLAMP (PC) 4.93 (118.32) 24 24 5 E-5572A-BK CLAMP (PC) 2.96 71.04 CREDIT DO NOT PAY ($47.28) Parts & Service Freight Taxes ($47.28) $.00 $.00 F1eetPride makes NO WARRANTY OF MERCHANTABILITY with respect to any goods sold. There are no warranties which extend beyond the description of any goods sold on the invoice describing them. It is expressly agreed that Applicant s sole remedy for breach of any warranty with respect to goods or work is limited to the money actually received by FLEETPRIDE for the goods or work; the remedy of consequential damages is expressly excluded. It is agreed that payment of the cash price is due within the terms stated above. A SERVICE CHARGE OF 1.5% per month (lox PER ANNUM) shall be due upon the amount of any charge which has not been paid when due. PLEASE PAY FROM THIS INVOICE. CORES MUST BE RETURNED WITHIN 60 DAYS TO BE ELIGIBLE FOR CREDIT. 348 IND CCI_L11 PARMENDARI 11/02/16 16.04.25 All Claims and returned goods MUST be accompanied by this bill. Page 1 Of 1 RECEIVED BY REMIT FlootPride0 INVOICE FEETPRDE. PO BOX 847118 TRUCK& TRAILER PARTS 57958931 DALLAS TX 75284-7118 (361) 883-4358 EXT 4000 WWW.FLEETPRIDE.COM INDIANAPOLIS IN 1140 S WEST ST (317) 632-4487 STORE NO. SHIP LOC. INVOICE TYPE QUOTE INVOICE DATE INVOICE NUMBER 352 11 IND I CHARGE SALE 12/04/13 57958931 SOLD TO CARMEL STREET DEPT. SHIP TO CARMEL STREET DEPT. 3400 W 131ST ST CARMEL IN 46074-8267 3400 W 131ST ST (317)-733-2001 WESTFIELD IN 46074-8267 CHECK NO. SHIPPER NAME ORIG. INVOICE N0. FREIGHT BILL OF LADING TERMS WILL CALL NET 30 PURCHASE ORDER NO. REQUISITION/JOB NUMBER ORDERED BY ACCOUNT SALESMAN TRUCK28 JEFF 302461 345 QUANTITY MFG. PART NUMBER DESCRIPTION UNIT PRICE AMOUNT ORD. SHIPPED CODE 1 1 14 29SS4 PUSH PULL SOLENOID VALVE (EA) 106.92 106.92 INVOICE TOTAL $ 106.92 Parts & Service Freight Taxes $106.92 $.00 $.00 FleetPride makes NO WARRANTY OF MERCHANTABILITY with respect to any goods sold. There are no warranties which extend beyond the description of any goods sold on the invoice describing them. It is expressly agreed that Applicant s sole remedy for breach of any warranty with respect to goods or work is limited to the money actually received by FLEETPRIDE for the goods or work; the remedy. of consequential damages is expressly excluded. It is agreed that payment of the cash price is due within the terms stated above. A SERVICE CHARGE OF 1.5% per month (18% PER ANNUM) shall be due upon the amount of any charge which has not been paid when due. PLEASE PAY FROM THIS INVOICE. CORES MUST BE RETURNED WITHIN 60 DAYS TO BE ELIGIBLE FOR CREDIT. 348 IND CCI_L11 PARMENDARI 11/02/16 16.04.25 All Claims and returned goods MUST be accompanied by this bill. Page 1 Of 1 RECEIVED BY From:FLEETPRIDE To:3177332005 CARMEL STREET DEPT. Msg#8320544.0.1 11/02/2016 14:09 Page 2 of 2 0 REMIT TO: F.IzetFrido INVOICE FLEETPRIDE PO BOX 847118 TRUCK& TRAILER PARTS 80931010 DALLAS TX 75284-7118 (361) 883-4358 EXT 4000 WWW.FLEETPRIDE.COM INDIANAPOLIS IN 1140 S WEST ST (317) 632-4487 STORE NO. SHIP LOC. INVOICE TYPE I INVOICE DATE INVOICE NUMBER 352 11 IND CHARGE SALE L 11/02/16 80931010 SOLD TO CARMEL STREET DEPT. SHIP TO CARMEL STREET DEPT. 3400 W 131ST ST 3400 W 131ST ST CARMEL IN 46074-8267 WESTFIELD IN 46074-8267 (317)-733-2001 CHECK N0. SHIPPER NAME ORIG. INVOICE NO. FREIGHT BILL OF LADING TERMS DELIVERED NET 30 PURCHASE ORDER NO. REQUISITION/JOB NUMBER ORDERED BY ACCOUNT SALESMAN MIKE 302461 356 UANTITY MFG. PART NUMBER DESCRIPTION UNIT PRICE AMOUNT ORD. SHIPPED ICODE 18 18 845 PT8306-10 FILTER, HYDRAULIC ELEMENT (EA) 6.47 116.46 18 18 845 BF1223-0 FUEL/WATER SEPARATOR SPIN-ON W 18.09 325.62 (EA) 18, 18 153 FF63009 USER FRIENDLY FUEL FILTER (EA) 39.07 703.26 18 18 845 BD7309 FILTER, HIGH VELOCITY 22.55 405.90 DUAL-FLOW LUBE 5 (EA) 18 18 3035 P621097 POWERCORE AIR FILTER (EA) 153.84 2,769.12 INVOICE TOTAL $ 4,320.36 Parts & Service Freight Taxes $4,320.36 $.00 $.00 FleetPride makes NO WARRANTY OF MERCHANTABILITY with respect to any goods sold. There are no warranties which extend beyond the description of any goods sold on the invoice describing them. It is expressly agreed that Applicant s sole remedy for breach of any warranty with respect to goods or work is limited to the money actually received by FLEETPRIDE for the goods or work; the remedy of consequential damages is expressly excluded. It is agreed that payment of the cash price is due within the terms stated above. A SERVICE CHARGE OF 1.5% per month (18% PER ANNUM) shall be due upon the amount of any charge which has not been paid when due. PLEASE PAY FROM THIS INVOICE. CORES MUST BE RETURNED WITHIN 60 DAYS TO BE ELIGIBLE FOR CREDIT. , 348 IND IND_D3 MBAUER 11/02/16 14.05.01 All Claims and returned goods MUST be accompanied by this bill. Page 1 of 1 Customer Copy RECEIVED BY ootPride © REMIT IDE INVOICE ELEETPRIDE PO BOX 847118 TRUCK& TRAILER PARTS 80950372 DALLAS TX 75284-7118 (361) 883-4358 EXT 4000 WWW.FLEETPRIDE.COM INDIANAPOLIS IN 1140 S WEST ST (317) 632-4487 STORE NO. SHIP LOC. INVOICE TYPE QUOTE INVOICE DATE INVOICE NUMBER 352 1 IND CHARGE SALE 11/03/16 80950372 SOLD TO CARMEL STREET DEPT. SHIP TO CARMEL STREET DEPT. 3400 W 131ST ST CARMEL IN 46074-8267 3400 W 131ST ST (317)-733-2001 WESTFIELD IN 46074-8267 CHECK NO. SHIPPER NAME ORIG. INVOICE N0. FREIGHT BILL OF LADING TERMS DELIVERED NET 30 PURCHASE ORDER NO. REQUISITION/JOB NUMBER ORDERED BY ACCOUNT SALESMAN MIKE 302461 335 UANTITY MFG. ORD. SHIPPED CODE PART NUMBER DESCRIPTION UNIT PRICE AMOUNT 2 2 845 BD7250 FILTER, HIGH VELOCITY 24.43 48.86 DUAL-FLOW LUBE S (EA) 2 2 845 B7039 FILTER, LUBE SPIN-ON (EA) 7.95 15.90 4 4 845 PF7978 FUEL/WATER SEPARATOR ELEMENT 34.95 139.80 (EA) 2 2 845 RS4636 FILTER, RADIAL SEAL OUTER AIR 33.85 67.70 ELEMENT (EA) INVOICE TOTAL $ 272.26 Parts & Service E Freight Taxes $272.26 $.00 $.00 F1eetPride makes NO WARRANTY OF MERCHANTABILITY with respect to any goods sold. There are no warranties which extend beyond the description of any goods sold on the invoice describing them. It is expressly agreed that Applicant s sole remedy for breach of any warranty with respect to goods or work is limited to the money actually received by FLEETPRIDE for the goods or work; the remedy of consequential damages is expressly excluded. It is agreed that payment of the cash price is due within the terms stated above. A SERVICE CHARGE OF 1.S% per month (18% PER ANNUM) shall be due upon the amount of any charge which has not been paid when due. PLEASE PAY FROH THIS INVOICE. CORES MUST BE RETURNED WITHIN 60 DAYS TO BE ELIGIBLE FOR CREDIT. 348 IND IND_SAVE JLANDIS2 11/04/16 16.08.40 All Claims and returned goods MUST be accompanied by this bill. Page 1 Of 1 RECEIVED BY ootPride0 REMIT TO: INVOICE ELEETPRIDE PO BOX 847118 TRUCK A TRAILER PARTS 80981845 DALLAS TX 75284-7118 (361) 883-4358 EXT 4000 WWW.FLEETPRIDE.COM INDIANAPOLIS IN 1140 S WEST ST (317) 632-4487 STORE NO. SHIP LOC. = INVOICE TYPE QUOTEINVOICE DATE INVOICE NUMBER 352 IND CHARGE SALE 11/04/16 80981845 SOLD TO CARMEL STREET DEPT. SHIP TO CARMEL STREET DEPT. 3400 W 131ST ST CARMEL IN 46074-8267 3400 W 131ST ST (317)-733-2001 WESTFIELD IN 46074-8267 CHECK NO. SHIPPER NAME ORIG. INVOICE NO. FREIGHT BILL OF LADING TERMS PP & ADD DELIVERED NET 30 PURCHASE ORDER NO. REQUISITION/JOB NUMBER ORDERED BY ACCOUNT SALESMAN MIKE 302461 356 UANTITY MFG. PART NUMBER DESCRIPTION UNIT PRICE AMOUNT ORD. SHIPPED CODE *NOTE* AUTO BO TICKET 2 2 20 GC3036LCW COMB.BRAKE CHAMBER-3036, 144.74 289.48 WELDED CLEVIS (EA) INVOICE TOTAL $ 289.48 Parts & Service Freight Taxes $289.48 $.00 $.00 FleetPride makes NO WARRANTY OF MERCHANTABILITY with respect to any goods sold. There are no warranties which extend beyond the description of any goods sold on the invoice describing them. It is expressly agreed that Applicant s sole remedy for breach of any warranty with respect to goods or work is limited to the money actually received by FLEETPRIDE for the goods or work; the remedy of consequential damages is expressly excluded. It is agreed that payment of the cash price is due within the terms stated above. A SERVICE CHARGE OF 1.5% per month (18% PER ANNUM) shall be due upon the amount of any charge which has not been paid when due. PLEASE PAY FROM THIS INVOICE. CORES MUST BE RETURNED WITHIN 60 DAYS TO BE ELIGIBLE FOR CREDIT. 348 IND IND_SAVE JLANDIS2 11/04/16 16.08.40 All Claims and returned goods MUST be accompanied by this bill. Page 1 Of 1 RECEIVED BY