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Home My WebLink About156617 02/21/2008 CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 1 ONE CIVIC SQUARE HINCKLEY SPRINGS CARMEL, INDIANA 46032 PO BOX 660579 CHECK AMOUNT: $39.56 DALLAS TX 75266 -0579 CHECK NUMBER: 156617 CHECK DATE: 2/21/2008 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1301 4239099 080243042005 39.56 OTHER MISCELLANOUS HINCKLEY SPRINGS WATER WArER.COM r ORIGINAL CUS I GMER 1722uu4 I*ICKFI 101' Location 2677668 PO#: CARMEL C I I Y COLIW [Lto; 01124108 Time: 8:02: -,w) I civil: SO RUUIE# 3042 LEE CARMEL, IN 46032 1 P p I oduc I De I i V, I '-d Lily PR ICE AMOLIN I [is SG PDR- -'/H 3 16.49 L HS 5G Oepos i is 3 46.00 $18.00 DOT 5.0G PLS >IJ -3 36,110 $-18.u0 Fp ty iw',! 0 J. Subtotal Sales 25.47 Sales Tax 0.00 UFLIVEHY TICKET IOIAI. 25.47 Pievious Account Balance 30.98 Total Balance 0-,e 56.45 Payments: ENDING BALANCE 56.45 Next Delivery Date: 2/2112008 We bill fm!lthly 1'y ;nvoitt:. retn n f.,, p'll ltn.upds. Hinckley Springs LH IkI' e a brand of For Customer Service and Account Inquiries, hi L e y DS Waters of America, Inc. Call 7 -800- 444 -PURE (7873) or visit Springs( PO Box 660579 Dallas, TX 75266 -0579 www.hinckleysprings.com Customer Account 17220042677859 KIM ROTT Your Next Deliveries: Invoice Date: 01 -26 -08 CARMEL CITY COURT 02 -21 -08 Invoice 0108 1722004 2677859 1 civic so 03 20 08 CARMEL, IN 46032 Purchase Order Date Details Qty. Each Amount Previous Balance 30.98 Payment 0.00 Remaining Balance 30.98 01 -24 -08 TRANSACTION T080243042005 HINCKLEY 5.OG PURIFIED DRINK 3 8.49 25.47 5.0 GAL BOTTLE DEPOSIT 3 6 -00 18.00 5.0 GAL BOTTLE RETURN -3 6.00 -18.00 Sales Tax Total 25.47 80243042.005 01 -24 -08 TRANSACTION 26122426 ENERGY SURCHARGE 1 2.09 2.09 Sales Tax 0.00 Total 2.09 01 -24 -08 TRANSACTION 080242494748 HOT AND COLD COOLER RENTAL 1 12.00 12.00 Sales Tax 0.00 Total Total New Charges 39.56 Finding your next scheduled delivery day just got easier! View and print your 2008 Delivery Calendar online at www.water.com. aosss P -000a Log onto your account or register today. Click on Printable Calendar. Previous Balance Payment Total Hew Charges Pay This Amount $30.98 0 $0.00 $39.56 r= $70.54 v Write the com plete account number on y our check Detach remittance and mail with pa yment in the enclosed envelope. To pay online g o to www.hinckle ysprings.com v How to Read Your Statement Visit our Website• munl IipkM.. Register online for access to your account. You can view and pay your bill, check delivery schedule and order Customer Account Number: L. o o h,y products all online. For prompt service, please use this number when referring to your account. E Summary: ww° Bottle Deposits: Highlights l ottle deposits and returns. Balance from previous bill (previous balance minus payments). Easy to Pay: m You can pay through the mail, online, or call us Easy to r Read: to expedite your remittance with automatic_ credit All charges and credits are easy card payments. to understand. i Io�eoonnou Total New Charges: -A t„ This information provides totals for k m., Mail Remittance With Payment To: various products and transactions. °ASCeEFM Please detach remittance and mail using business envelope provided. L. II.,, II.. II, II.. IIII.I..I.IIII.II...IIII.I I..II,II,..ILIII.I..IL ..II.IJll.11ld Important Monthly Message I L..IIL.I IILII ILLLL LIILI L.IIL.I L II II MILLI JILL.I L LILILJ II....II..III....IIII.,I.. ozosto zooti3 isrz��ez3ssi°s3 0003600 a 000z000 6 0 Billing Rights Summary Electronic Funds Transfer Notice In case of Errors or Questions About Your Bill: If you pay by check, it will be converted into an "Electronic Funds Transfer" If you think your bill is incorrect, or if you need more information about a (EFT), a process in which your financial institution is electronically instructed to transaction on your bill, write us as soon as possible on a separate sheet, at transfer funds from your account to ours in lieu of processing the check. By P.O. Box 660579, Dallas,TX 75266 -0579. We must hear from you no later sending your completed check to us, you authorize us to use the account than 60 days after we sent you the first bill on which the error or problem information therein to create an EFT for the amount indicated on the check. If appeared. Your bill shall be deemed correct unless disputed within 60 days the EFT cannot be processed for technical or other reasons, you authorize us from receipt. You can telephone us, but doing so will not preserve your rights. to process an image replacement document, draft, or copy of your check. In our letter, give us the following information: OPT OUT NOTICE: If you do not wish to participate in this check conversion y g g program, please write to us on a separate sheet at: Your name and complete account number. P.O. Box 660579, Dallas, TX 75266 -0579. The dollar amount of the suspected error. Describe the error and explain why you believe there is an error. If you need Insufficient Funds Notice more information, describe the item you are unsure about. If your check is returned for insufficient or uncollected funds (NSF), your signature on your check gives us permission to debit your checking account electronically You do not have to pay any amount in question while we are investigating, but for the uncollected amount. Payment by check constitutes your acceptance of you are still obligated to pay the amount of your bill that is not in question. While these terms. we investigate your questions, we cannot report you as delinquent or take any action to collect the amount you question. We appreciate your business. As a food product, bottled water is subject to rules and regulations promulgated by the federal Food and Drug Administration (FDA). For further information, please write DS Waters of America, Inc. at P.O. Box 660579, Dallas, TX 75266 -0579. Prescnbedby State Board ofAccounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995) 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 Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) D� krq30! 0Q Y a.� Total S�p 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 VOUCHER NO. WARRANT NO. ALLOWED 20 i/ IN SUM OF 9 ON ACCOUNT OF APPROPRIATION FOR Board Members D 9 n INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or I Joy 30 5�d 3�J0 `i 9 39. 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 20 Signature Cost distribution ledger classification if claim paid motor vehicle highway fund