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311590 5/30/2017
CITY OF CARMEL, INDIANA VENDOR: 360202 CHECK AMOUNT: $ 395.27 t k t k R t N 982-PRAXAIR DISTRIBUTION INC CHECK NUMBER: 311590 ONE CIVIC SQUARE DEPT CH 10660 CARMEL, INDIANA 46032 PALATINE IL 60055-0660 CHECK DATE: 05130117 AMOUNT DESCRIPTION DEPARTMENT ACCOUNT PO NUMBER �N30I1658MBER 395.27 BOTTLED GAS 1120 4231100 O c < « o m O / q / O U) § 0 CL\ ® \ k 0 # > 2 ? # :E C) t % { 0 E o 0 2 CL 4 k k q E Q 0 (0 § 0 a q 2 0 w [ \ 4 k e / 0 ] - \ o \ k 20 O D / \ E \ � k ƒ 3 CL . � 2 / 692 O O | § k E m KJ z CD\ ® $ 5 a i e �_ - # E $ g ^ @ c 0 { i g k / 2 J 0 m e 0 2 G - o / ( § f a - c Gf 2 / 2 \ / CL § / a m - E m o ƒ % 3 § k E 4 / Fa- (D \ 0 = / mCD EF M _ \ i @ �< 8 e; ( § & * $ k ƒ C) « f c � 7 , - 7 - # 7 0 } \CD } / .\ CD / cr CD CD } D C',\� - \ / ( nk 2 � < g $ o 0 [7 � o k0 _0 c m m \ k ( 2 \ m ® _ \ f \ C) Z n § OL § k C) Cf) \ 7� E 2 0< \ \ \ ® - �¥ o o D §o \ ko §f \ § \ s . 0 0 / / j E - \ \ r 0 f ( z E ] \ m C ƒ R \ c § \ / 0 ® § 2 ° \ 2. ] \ / \ \ / \ X » ] � � © z » \ \ § E to2 Q ; ;D E $ 2 f m ] ¥ PLCMZACUCIMIiI"IMIVURCIURIV IllrrvRIIVIYVVIIn—11-111 QUESTIONS: COMMENTS: Please note the format of your invoice has changed and now includes more information to help you manage your Praxair account. PRAXAIR DISTRIBUTION,INC. CUSTOMER SERVICE 1400 POLCO ST If you wish to receive the document electronically in the future,please contact us. INDIANAPOLIS IN 46222 800-266-4369 Pay your bill by credit card! Call 1-800-266-4369 to start. INVOICE DETAIL AND PURCHASE DESCRIPTION TERMS: Net 10 Days ITEM NUMBER ITEM DESCRIPTION CITY CITY SHIP RETN BACK ORDER INVOICE NO:77301658 CUSTOMER:71675029 DATE:5/9/2017 SHIP FROM 70613,PXPKG INDIANAPOLIS IN HS ORDER REFERENCE 91466691 DT 5/8/2017 PT# CUSTOMER PO/RELEASE TOM VERBAL SHIP VIA Our Truck SHIP TO ACCOUNT:76168978 TOM 317-741-0153 OX M-AD OXYGEN USP AD 10 9 CO 25.36 253.60 N OX M-M OXYGEN USP M 3 3 CO 29.74 89.22 N UMSCFCD2 ENERGY AND FUEL CHARGE USSURFEE 1 EA 12.50 12.50 N UZZZHMD3 HAZARDOUS MATERIAL CHARGE USSURFEE 1 EA 13.95 13.95 N UDELIVERYCHARGE DELIVERY CHARGE USSURFEE 1 EA 26.00 26.00 N Total Cylinders Shipped/Returned 13 12 ACCOUNTS PAST DUE WLL BE CHARGED PLEASE NOTE PAYMENT OF THIS INVOICE ACKNOWLEDGES THAT SUBTOTAL TAX AMOUNT A SERVICE CHARGE OF$1 OR A FINANCE THE ABOVE SHPMENTS,RETURNS,ANDIOR BALANCE OF THE CHARGE OF 1.5%PER MONTH(18% PRAXAR CYLINDERS N YOUR POSSESSION IS CORRECT AT THE ANNUAL RAT)OF THE OUTSTAING BALANCE,WEHICHEVER IS GGREATER OR CLOSE OF BUSINESS ON THE DATE SHOWN ON THIS INVOICE. 395.27 0.00 USD $ 395.27 CONTRACTUALLY ALLOWED. 343-01F