HomeMy WebLinkAbout203020 10/25/2011 CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 1
s ONE CIVIC SQUARE HINCKLEY SPRINGS CHECK AMOUNT: $62.81
CARMEL, INDIANA 46032 PO BOX 660579
DALLAS TX 75266 -0579 CHECK NUMBER: 203020
CHECK DATE: 10/25/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1301 4239099 2677859 62.81 OTHER MISCELLANOUS
1- 800-4- WATERS 492 -8377 www.HinckleySprings.com
Upcoming Delivery Dates eliv rs
Hinckley 'fie
October November December Springsf Bottled Water Filtration Coffee
Thursday, 27 Thursday, 10 Thursday, 8 Take action during Breast Cancer Awareness Month.
Thursday, 22 Add a case of Athena to your next order.
A minimum of $1 million related to the sale of
Athena will go to breast cancer awareness,
education and research by 2014.
Customer Account 17220042677859
KIM ROTT Invoice Date: 10 -15 -11
CARMEL CITY COURT
1 CIVIC SO Invoice 2677859 101511
CARMEL, IN 46032 Purchase Order
Date Transaction Details Qty. Each Amount
Previous Balance 65.84
10 -11 -11 P202147 Payment Check 202147 Thank You -65.84
Remaining Balance 0.00
R112632494748 WHITE HOT AND COLD COOLER RENTAL 1.0 13.50 13.50
09 -29 -11 T112723042004 HINCKLEY SPRINGS 5G DRINK NON -SPILL 2.0 9.99 19.98
CUP PLASTIC FLAT 9 OZ HINCKLEY SPRINGS 50 CT 2.0 3.49 6.98
5.0 GALLON BOTTLE RETURN -2.0 6.00 -12.00
5.0 GALLON BOTTLE DEPOSIT 2.0 6.00 12.00
Rec'd By: Not Available or Refused
10 -13 -11 68076298 ENERGY SURCHARGE 1.0 2.37 2.37
10 -13 -11 T112863042009 HINCKLEY SPRINGS 5G DRINK NON -SPILL 2.0 9.99 19.98
5.0 GALLON BOTTLE RETURN -2.0 6.00 -12.00
5.0 GALLON BOTTLE DEPOSIT 2.0 6.00 12.00
Rec'd By: Not Available or Refused
Total New Charges 62.81
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30356-P -0034
Previous Balance Payment Total New Charges Pay This Amount
$65.84 $65.84 $62.81 $62.81
Write the complete account number on your check. Detach remittance and mail with payment in the enclosed envelope. To pay online go to www,HinckleySprings.com
How to Read Your Statement Important Monthly Promotions:
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the next three months. products all online.
Customer Account Number: Bottle Deposits
For prompt service, please use this Highlights bottle deposits and returns.
number when referring to your account.
Easy to Pay:
Pay your invoice through the mail, online at
Summary: www.water.com or call us to expedite your
Previous balance and posted remittance with automatic credit card payments
payments since last bill.
O
C n
Total New Charges:m•
This information rovides totals for
p n Mail Remittance With Payment To:
various products and transactions. Please detach remittance and mail
ahc using business envelope provided.
IILI-1' 11,11'.11 J.1,1 ,ILL.1- 11.1..I 11 u.n n.mm.,— wnn P—
Monthly Message
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 your letter, give us the following information: OPT OUT NOTICE: If you do not wish to participate in this check conversion
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.
Prescribed by State Board of Accounts 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
Ivi /X 'r I a 16' Xe41) Purchase Order No.
0 7 Terms
0 ,E Lt' Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
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 -1.6.
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF
71 77
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
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
Cjr_�
cSIgn t
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund