191951 11/22/2010 (9) CITY OF CARMEL, INDIANA VENDOR: 00352984 Page 1 of 1
ONE CIVIC SQUARE FLEET SERVICES CHECK AMOUNT: $103.18
CARMEL, INDIANA 46032 0453 -00- 7946296
PO BOX 6293 CHECK NUMBER: 191951
CAROL STREAM IL 60197
CHECK DATE: 11122!2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4231400 049600138007 103.18 0496 -00- 137008 -0
Invoice Statement
INVOICE NUMBER: 24322564
LN O ACCOUNT NAME: City of Carmel Police
PAGE 1 OF 1
ACCOUNT NUMBER CREDIT LIMIT DAYS THIS PERIOD BILL CLOSING DATE PAYMENT DUE DATE AMOUNT DUE
0496 00 138007 0 2,100.00 31 OCT 31 2010 NOV 26 2010 103.18
DATE ACTIVITY DESCRIPTION CHARGESIDEBITS PAYMENTS /CREDITS
OCT -29 -2010 FUEL PURCHASES 103.18
REMINDER
REMINDER PLEASE BE SURE TO INCLUDE REMITTANCE STUB
WITH PAYMENT. MAIL TO THE ADDRESS SHOWN IN THE
RIGHT PORTION OF THE REMITTANCE STUB.
PURCHASES, RETURNS AND PAYMENTS MADE JUST PRIOR TO BILLING DATE MAY NOT APPEAR UNTIL THE NEXT INVOICE/STATEMENT.
PREVIOUS BALANCE IpAVMENTS +jPURCHASES +)DEBITS )CREDITS +ILATE FEE �(-)NEWBALANCE 0.00 0.00 103.18 0.00 0.00 0.00
CALL CUSTOMER SERVICE TO PAY BY PHONE
FEDERAL TAX ID: 841425616 The Late Fee is determined by Which is an EFFECTIVE ANNUAL To the balance subject to late
a pplying a monthly rate of RATE of fee for this period which is
2.00 24.00 0.00
SEE REVERSE SIDE FOR IMPORTA INFORMATION AND TERMS.
Balance Subject to Late Fee Payment Options
The late fee will be calculated by determining the total balance Mail
due on the date your account becomes delinquent, as follows: Be sure to include bottom portion of invoice with your payment.
adding the total amount due on your account on the payment due Write your account number or invoice number on the check to help
date together with any purchases posted to your account from avoid delays in payment processing if the check and remit stub
the end of the last billing cycle through the payment due date and become separated.
subtracting from that amount any payments and /or credits entered
during that period. The total balance due will then be multiplied Allow 10 business days prior to the due date for mailing to help
by the applicable periodic rate to determine your late fee. In the avoid late fees. Mail payments to:
event that the calculated late fee is less than ten dollars ($10.00), Fleet Services
a minimum late fee of ten dollars ($10.00) will be charged. PO Box 6293
Your account will be delinquent if you do not pay it in full within Carol Stream, IL 60197 -6293
26 calendar days of the billing date appearing on your invoice. Online
Certain customers, based upon our credit review, may be required Authorized users can elect to receive an email notification when an
to make payment in less than 26 calendar days on a cycle that we invoice is ready for online viewing and payment. Log in or register to
may establish for you. In addition, certain customers may elect a set up an online account at www.wextools.com.
shorter billing or payment cycle as offered by us.
Online payments scheduled by 3:00 PM ET (on business days)
If your payment due date falls on a non business day, payment is are credited to your account on the same day. There is no fee for
due on the business day before the payment due date. Delinquent online payments.
accounts will be subject to late fees, suspension, or termination
of credit privileges, without notice. All charges must be paid in Phone
full regardless of disputes. Charges must be disputed in writing Call Customer Service at 1- 866 -544 -1715 and select the menu
no later than sixty (60) days from the billing date or they will be option for Billing Inquiries. In addition to making a payment, you can
considered final and binding. also check your balance.
Card Issuer Payments scheduled by 3:00 PM ET (on business days)
The Circle K Fleet Card is issued by, and all card transactions are credited to your account on the same day.
are funded by and payable to, Wright Express Financial Services Be prepared with your fleet card account number and a sample
Corporation, under a Business Charge Account Agreement with check to enter your bank account number and routing number.
the cardholder named on the reverse. There is no fee for phone payments.
Customer Service Automated Clearing House (ACH)
For account Inquiries and correspondence in regard to account To make a one -time electronic payment go to:
service or billing: http: //www,e- fleet.com
Call 1 -866 -544 -1715, or ACH payments made by 2:30 PM ET (on business days) are
credited to your account on the same day. There is a fee for each
Fax to 1- 800 395 -0809, or ACH payment.
Mail to P.O. Box 639, Portland, ME 04104
Be sure to include your account number on all correspondence.
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 4995)
CITY OF CARMEL
An invoice or 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
Fleet Services Purchase Order No.
P.O. Box 6293 Terms
Carol Stream, IL 60197 -6293 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
11 /1.6 /,TO 24322564 payment for gasoline 103.18
Total
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 -1.8.
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
F "ieet Services
IN SUM OF
P.O. Box 6293
Carol Stream, IL 60197 -6293
103.18
ON ACCOUNT OF APPROPRIATION FOR
police general fund
P A00-7 C' Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
o£ I hereby certify that the attached invoice(s), or
1110 24322564 314 103.18 bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
November 16r� 20 10
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund