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307223 1/20/17 Q CITY OF CARMEL, INDIANA VENDOR: 365677 GORDON FOOD SERVICE, INCCHECK AMOUNT: $•******'61.70" ONE CIVIC SQUARE Po box e8o2s CHECK NUMBER: 307223 CARMEL, INDIANA 46032 CHICAGO IL 60680-1029 CHECK DATE: 01/20117 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 92088696 28.75 FOOD & BEVERAGES 1207 4239040 1207 4239040 926086095 32.95 FOOD & BEVERAGES 0 -0 Q < « / G \ 3 f 2 q k ? q ¥ a 2 > o O k n / ® / / 9 k \ ? = m w m = 2 @ C o (D 0 k \ \ o 2 0) O\ O o w = « 0 \ \cn pr O p m $ m - -n - / < S \ 0 � m G / § \ K \ 0 � ■ E / C z 2 } 2 -n O O | $ } m \ $) ¥ $ _ J a i 3 L � # k $ § / ƒ E E \ i =ƒ 7 7 $ CD 0) o ? G c 0 3 / _ E / \ m # f / w { , [ & [ - E - § % 3 § \ 42 CD ° k 0 2 \ - © k § i ƒ � ca // , q ( R E Ef 8 ƒ E Z 3 a | o [ CL 0# t_ m ° c : 0 > E. \ k$ -4 § ) \ 0. E \ � � � > .« ) / # m / 8 < _ k o// S ƒ k ] C§ (k ) 0 CD \ / \ Kk k [ \ 2 0 D )o � -n CD $f, $R fu = a E in LT M \ \ / \ 2 o \ / j E CD c j E O / f k/ z E ] ¢ / fc C / ) \ 2 / n k § m f ( ] f A « ] a ƒ � \ \ ) I 2 & § ƒ _ 0 \ E � \ § q /O 3 E O i \ 2 z / 3 0 D Q x O 2 # � Cr 0 q 7 -n w q m @ \ / k m < o 2 q Q \ O \ � o o w = $ a S m cn O 9 § @ ■ -n @ / \ § C � U m O � a S z k § \ CL \ 0 T X 3 ■ _ c 0). CD z 3 7 O 2 > m / / § 0 O CO Z | 7 C ¥ 5 z k< g [ / E % ; 0 F 2 0 m E ] 0 ® G k § G @ ° E U k a CD C- C - E I ) % 3 § 2 (D \ i ± / Z \ / co 0 o ,J E w E ƒ ( f (D § | o / k C # § m o i f ƒ kƒ � \ j m \ / / ) K r D \ CD ) C-) 7 § ( 8 m < o 0 E C o « 7 CD 0) § m ƒ k C o 20 co � \ \ \ � %k k k # \° ° D ƒ CD \ 2 -< )� } o = > b)L7 o ƒ \ \ oCL \ Q . ?VV / \ E \ r 0 ƒ ) A ECD C % " 0 CD CD 2. \ z -n k § f \ CD ] § K 2 P ° CL - \ CD \ \ § ED Page:1 of 1 Gordon P.O.Box1787 INVOICE GrandRFOOD SERVICE STORE www.gfsMI ccom INVOICE# DATE 1-800-968-7500 926086095 1008/2016 TAIL ROUTING# STOP If CUSTOMER# PURCHASE ORDER SALES If REPRESENTATIVE MP# MP LOCATION TERMS N 100133245 1906 INDY-FISHERS IN MP153 OUT 1905 Fishers Net 30 Days SHIP TO: Brookshire Golf Club 12120 Brookshire Pkwy Carmel,IN 46033 ITEM CODE QTY DESCRIPTION CAT COST GUIDE SPECS UNIT PRICE TAX AMOUNT 1910431 1 EACH CHEESE CHED MLD SHRD FINE 4-5#GFS 6 10.99 10.99 4133201 1 EACH MACARONI ELBOW 4-5#GFS 1 5.99 5,99 2852181 2 EACH SOUR CREAM 4-5#GFS 6 6.99 13,98 4514360 1 CASE HOT DOG BUNS 6"12CT GFS 1 1.99 1.99 1,99 PRODUCT CATEGORY SUMMARY NUMBER OF PIECES SUBTOTAL 32.95 1-GROCERY 2-FROZEN -MEAT 4-SEAFOOD 7.98 FREEZER COOLER WAREHOUSE MISC. TOTAL TAX 5-POULTRY 6-DAIRY -DISPOSABLE 8-SANITATION Customer's signature evidences receipt of all items listed and its promise to pay INVOICE TOTAL 32.95 24.97 the amount due to GFS.Customer agrees that if a check draft and/or order of 9-0ISP.BEVG 10-PRODUCE 11-TABLETOP payment(Transaction")issued for payment of this invoice is dishonored,GFS may re-present the Transaction and issue a draft against the account upon which the Transaction is drawn for a fee up to the maximum permitted by law. PAID 0.00 TOTALS BY TAX CATEGORY Received By: SALE NBR 17 %RATE TAX %RATE TAX 11 (� LANE NBR 02 The perishable agrialturaI commodities shown on this invoice are sold subject to the USER ID statutory trust authorized by section 5(c)of the Perishable Agricultural Commodities ` Act,1930(7 U.S.0 499e(c)).The seller of these commodities retains a trust claim over DATE 10/26/2016 these commodities,all inventories of food or other products derived from these commodities and any receivable or proceeds from the sale of these commodities until TIME(GMT) 12:15:00 full payment is received.Eggs delivered in the state of Illinois include an Illinois Egg Signature: Inspection Fee in the price.Maryland MDA Inspection Fees at a rate of E.OS per dozen _______'Acceptance constitutes aareement to a time price differential of 1 112%per month on the unpaid balance after the due date