HomeMy WebLinkAbout314194 7/31/2017 '� CITY OF CARMEL, INDIANA VENDOR: 367794
�: �,. CHECK AMOUNT: $"""""102.37"
€ ONE CIVIC SQUARE TAKEFORM
". CARMEL, INDIANA 46032 11601 MAPLE RIDGE ROAD CHECK NUMBER: 314194
MEDINA NY 14103 CHECK DATE: 07/31/17
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1091 4230200 62434 102.37 OFFICE SUPPLIES
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by
whom rates per day, number of hours rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
367794 Takeform Terms
11601 Maple Ridge Road
Medina, NY 14103
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
7/7/17 62434 Workstation Signs xx5484 $ 102.37
Total $ 102.37
1 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
Clerk-Treasurer
Quorum Group, LLC. DBA Invoice#: 62434
takInvoice Date: 7/7/17, c f 0 r IT,
11601 Maple Ridge Roadj l l 1 01PO M XX-5484
Medina, NY 14103
800-528-1398 `Payment Terms: Net 30
y
Bill To: Carmel Clay Parks &Recreation Ph: (317) 573-4026
Fax: (317) 571-4136
Attn: Susan Beaurain Email: sbeaurain@carmelclayparks.com
1411 E. 116th Street
Carmel, IN 46032
Job Name: CAR0061: Monon Community Center
tion Quantity Unit Net Net
Line Descri
p y Price Price Ext
1 Type L.2: 5x5 Workstation (Tape Mount) 3 28.16 84.48
2 A0100 Silicone Adhesive Tube 1 10.89 10.89
Net Subtotal: $95.37
Shipping and Handling: $7.00
Net Total:
Balance Due(USD): $102.37
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
Invoice #
❑Visa MasterCard Discover American Express
Balance Due: $102.37
Cardholder's Name:
Card Number: C
Expiration Date:
Card Billing Address:
Signature:
Print Date:7/10/2017 8:24:31AM Page 1 of 1