177264 09/15/2009 CITY OF CARMEL, INDIANA VENDOR: 363346 Page 1 of 1
ONE CIVIC SQUARE INDY BALLOONS.COM
CARMEL, INDIANA 46032 PO BOX 90021 CHECK AMOUNT: $225.00
INDIANAPOLIS IN 46240
CHECK NUMBER: 177264
CHECK DATE: 9/15/2009
D EPARTMENT ACCOUNT PO NUMBE IN VOICE NUMBER AMOUNT DESCRIPTION
851 5023990 225.00 OTHER EXPENSES
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El Client has been advised,of balloon floating times
El Client has been advised of payment policies
An add -on gift' item is part of this order
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FORMS OF PAYMENT. (select one) 'Sub Total: 5
1. Credit Card Visa MC Amex Disc
Delivery
Exp
Set Up /5tnke
Billing Zip Code Security Code or Billing Fie: REMITTANCEI Date
Name on Card Pre -Tax Total
Total Due)
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2. Billing Account $35.00 service fee IN Tax:
AP: De oslt:
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Days ry Sub Total: i
3. Check 14 Da s Prior to Delivery Ref:
A CHECK DUE UPON DELIVERY w 73'
i1 BaI Due
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Delivered By Delivery Time Acc :epted BY
i BaLP:.aid:
Total Due;
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Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
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))
QNS
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
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
SEP 14 2009
'1
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20
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund