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166227 11/24/2008 CITY OF CARMEL, INDIANA VENDOR 361108 Page 1 of 1 ONE CIVIC SQUARE H S B C BUSINESS SOLUTIONS COS''Cp CHECK AMOUNT: $779.90 CARMEL, INDIANA 46032 rosox 5279 cnaoL sraenm a 60197-e219 CHECK NUMBER: 166227 CHECK DATE: 1112412008 DEPARTMENT ACCOUNT PO NUMBER INVOICE N AMOUNT DESCRIPTION 1046 4239037 351.81 7003731100072984 X 1046 4239039 38.95 7003731100072984 1047 4239039 389.14 7003731100072984 i I Please Direct Inquiries To 1 -800- 220 -8594 cosyco. COSTCO WF /OLESALE Account Number New Balance Payment Due Amount Past Due Due Date 703.7311- 0007 -2984 $892.09 $309.05 $.00 11/20/2008 Billing Date, Credit line Available Credit 10126/2008. $5,000 $4,107 "91 This communication serves as official notice that all calls to /from our offices may be monitored and /or recorded for quality assurance purposes STATEMENT OF YOUR ACCOUNT FINANCE CHARGE SUMMARY Credit Credit Average Daily Corres- FINANCE ANNUAL New Minimum Promo Plan Plan Daily Periodic ponding CHARGES at PERCENTAGE New Payment Expire Description Number Balance Rate APR Periodic Rate RATE Due Reg 00014 S888 0.00000% 00.00% Soo 0000% $309.05 5309.05 10/26/2008 Reg 00014 S38.87 0.00000% 00.00% 00 0000% S583.04 S.00 11126/2008 ACCOUNT DETAIL Transaction Transaction' Invoice User "P.O. Transactions Date Description Number ID Number Amount 09/26/2008 COSTCO WHOLESALE -346 030726 00005 5351.81 0 00005 SUBTOTAL: 5351.81 10/14/2008 COSTCO WHOLESALE -347 015916 00009 S3895 e 10/22/2008 COSTCO WHOLESALE -346 021790 00009 $333.67 e 10122/2008 COSTCO WHOLESALE- 346 063906 00009 S210.42 00009 SUBTOTAL: $583.04 m 10/18/2008 PAYMENT THANK YOU 00001 $661.29- 10/2222008 RETURN CARD If 009 00009 $42.76- o e 8y HO P03 ?0 ljVjq Return the below portion with payment. For billing errors or questions please refer to the back of the statement Page 1 of 2 Important Notice: Promptly review this statement and notify HSBC Business Solutions in writing of any errors or unautho- rized purchases. If you do not notify HSBC Business Solutions within 60 days of errors or unauthorized purchases, this statement will be presumed to be correct. Write to HSBC Business Solutions at P.O. Box 4160, Carol Stream, IL 60197 -4160. You may telephone HSBC Business Solutions at 1- 800 210 -8115, but it will not preserve your rights Notify HSBC Business Solutions in writing of the cancellation of a credit card or authorized user. co�rco coswo b1/HOLESALE ACCOUNT SUMMARY BALANCE SUMMARY C CURRENT 1 -29 DAYS PAST DUE 30 -59 DAYS PAST DUE Outs $661 29 +New $30905 00 00 Purchase(a)/Debrt(s) $93485 00.89 DAYS PAST DUE 90 -119 DAYS PAST DUE 120.149 DAYS PAST DUE New Fees 00 Finance Charges 00 00 00 00 Payment( $66129 150 -179 DAYS PAST DUE 100+ DAYS PAST DUE Credit(s) $4276 00 00 New Balance $89209 ur vr N Page 2 of 2 New address or phone number Please check box and complete reverse side Important Notice: Promptly review this statement and notify HSBC Business Solutions in writing of any errors or unautho- rized purchases. If you do not notify HSBC Business Solutions within 60 days of errors or unauthorized purchases, this statement will be presumed to be correct. Write to HSBC Business Solutions at P.O. Box 4160, Carol Stream, IL 60197 -4160. You may telephone HSBC Business Solutions at 1- 800 210 -8115, but it will not preserve your rights. Notify HSBC Business Solutions in writing of the cancellation of a credit card or authorized user. STMT222C (f OM7) TO ENSURE ACCURACY, PLEASE PRIM NEATLY USING UPPER -CASE LETTERS AND NUMBERS ONLY! Com an Name Email Address Street Number dSireet Number an� Stree Nam or the w ords Urn�t�or PlgO�f3�� cat Stat❑ M Ph n /❑❑❑—F_1❑FT_1 Costco Fund 1047 Club Gen Pro g Activity supplies supplies V# 361108 Invoice 4239039 4239037 09/26/08 3072600 351.81 PO #19380F 10/14/08 1591600 38.951 10/22/08 6390600 210.42 10/24/08 3962400 416.55 10/22/08 2179000 333.67 10122108 -4276 10/27/08 528.74 428.09 351.81 779.90 Costco Fund 1047 1O4(p TOTAL Club Gen Prog Activity supplies supplies 4 V# 361108 1 Invoice 4239039 239037 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 (Costco) Terms 361108 HSBC Business Solutions P.O. Box 5219 Date Due Carol Stream, IL 60197 -5219 Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) PO 19380 F 351 81 10126108 7003731100072984 Club Activit Su lies PO 19552 F 389.14 10126108 7003731100072984 General Pro ram su lies 38.95 10/26/08 700373110007298 General Program supplies Total 779.90 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 5-11-10-16 20_ Clerk- Treasurer Voucher No. Warrant No. (Costco) 361108 HSBC Business Solutions Allowed 20 P.O. Box 5219 Carol Stream, IL 60197 -5219 In Sum of 779.90 ON ACCOUNT OF APPROPRIATION FOR 104 Program Fund PO# or Board Members Dept# INVOICE NO ACCT #!TITLE AMOUNT 1046 7003731100072984 4239037 351.81 1 hereby certify that the attached invoice(s), or 1047 7003731100072984 4239039 389.14 bill(s) is (are) true and correct and that the 1046 7003731100072984 9d3 q 38.95 :materials or services itemized thereon for which charge is made were ordered and received except l 18 Nov 2008 Signature 779.90 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund