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315342 08/29/2017 94� ���M CITY OF CARMEL, INDIANA VENDOR: 154252 ONE CIVIC SQUARE INDIANA OXYGEN CO CHECK AMOUNT: S""*"*"*42.37* ;y ?Q CARMEL, INDIANA 46032 ND ANAPOL S81N asz�a CHECK NUMBER: 315342 < �.o CHECK DATE: 08/29/17 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 601 5023990 01636488 42.37 OTHER EXPENSES cu aEi c U O w (n �o O 14 J n n M M Ih � 0 Q Z O Q w C ;3 m d O w L CC tN0p U � 00 Q Q tNn Q1 N LL +� t OE 0000 i w U_ L cn L LNA W ~ (0 $ 0) UM u — > C7 0p (ri O > %DL •--� co —i U o > v 0 LnO co a0. Q Z L �_ n S o N E � � o m o - 0O. �Zi d U v ITEM ctT' �--can Blo DESCRIPTION UOM- — PRICE AMOUNT ** Location: A ** - CD SORE 1I 0 1 33.759' 1; CAREON DIOXIDE, 2.2 CYL 33.76 UN1013 (LIQUID WITHDRAW) 50CF @ 67.5180/1000F FSCFUEL SRCHGWC 10DIESEL SURCHARGE W/C EA 2.66 2.66 HMCHAZ MAT CHG 1 0' HAZARDOUS MATERIAL CHARGE EA 5.95 ' 5.95 Subto al 42.37 TOTAL CYLINDERS SHIPPED: 1 RETURNED: 11 Visit us on facebook or oft the web at wwi.indianaoxygen.pom Taxable amount: 0.00 CARMEL WATER CUSTOMER: 12598 • •ICE 42.37 THIS INV 3450 W 131ST ST INVOICE: 01636488 INCLUDING TAX CARMEL IN 46074-8267 INVOICEDATE: 08/03/17 ORDER: 02516036-00 P/O: INDIANA OXYGEN COMPANY • P.O. BOX 78588• INDIANAPOLIS, IN 46278-0588 INDIANAINDIANA OXYGEN COMPANY, INC. emu P.O. BOX 78588 DELIVERY TICKET INDIANAPOLIS, INDIANA 46278-0588 Bloomington Cincinnati + Elkhart + Fishers Fort Wayne + Indianapolis (812)330-9210 (513)353-2448 (574)295-4433 (317)841-0002 (260)918-0241 (317)290-0003 Lafayette + Marion Muncie Seymour Vincennes (765)474-7095 (765)662-8700 (765)289-2373 (812)522-4421 (812)882-4323 America's Oldest Gas/Welding Supply 398537o458 X458 CUSTOMER 12598 ORDER C)25 16036-00 CARMEL WATER 3450 W 131ST ST REEt' ORDER DATE 08/02/17 CARMEL IN 46032 PAGE 001 OF 001 317-733-2855 NAME CARMEL WATER TERR 007 $HIP VIA Will Call -Nim- INITIALS TIM P.O.# SALES O00 SHIP CODE 00 UPS 0 ORDER TYPE CHR6 REL# BRANCH 001 COUPPD PREPAID TIME 02-AUG-17 03:58PM PHONE# 317-733-2855 ROUTE# USERNAME timk QTY UNIT HM -------DESCRIPTION------------ ID LINE ------ITEM------ LOC QTY -CYLINDERS- VOLUME/ MIT EXTENDED SHIP & HAZARD CLASS NUMBER NO NUMBER ORDER SHIP REIN WEIGHT AMOUNT AMOUNT — - ------------------ i CYL CARBON DIOXIDE, 2.2 1 CD 5088 A I 1 1 50 33.759 U 76 UNIO13 (LIQUID WITHDRAW) 177.00 -------------- -- --------- QTY UNIT HM -------DESCRIPTION------------ LINE -----ITEM------ LOC QTY QTY BIN WEIGHT I UNIT EXTD - t.HAZARD OAS NO NUMBER ORDER WRD LOC AMOUNT AMOUNT ------------------------------ I EA DIESEL SURCHARGE W/C 2 FSC FUEL SRCHGWC A 1 0 .00 2.66 2.66 1 EA HAZARDOUS ARTERIAL CHARGE 3 HMC HAZ MAT CHG A 1 0 .00 5.95 5.95 Total Weight: 177.0000 Subtotal 42.37 i Tax .00 Freight .00 Total Sale 42.37 DELIVEREd lauG O4 SPWKLit:Pll:Y trig WSA LEPHONE NUMBER: 8005355053 PLACARDS: a ACCEPTED REFUSED Customer authorizes Seller to debit Customer's credit card or deduct f►om the TERMS&CONDITIONS HE CUSTOMER HEREIN CONSENTS TO AND CCEPTS THE ABOVE PRODUCTS Customer's deposit any outstanding balance remaining an the Customer's acit'oIJSVBJECTTOALL OFTHE CONDITIO FORTH ON RE RSESIDEHEREOF AND THE EXISTI TR -T ETWEEN BO' ART . IMPORTANT PLEASE READ CAREFULLY THE TERMS AND CONDITIONS OF SALE WHICH APPEAR RECEIVED BY(SIGNATURE) DATE ON THE REVERSE SIDE OF THIS DOCUMENT. ALL SALES MADE ARE SUBJECT TO SUCH TERMS AND CONDITIONS. CUSTOMER SIGNATURE HEREON VERIFIES X SHIPPED AND RETURNED RENTAL CYLINDER COUNT. SHIPPED BY CUSTOMER