213479 10/09/2012 a *f CITY OF CARMEL, INDIANA VENDOR: 361108 Page 1 of 1
` ONE CIVIC SQUARE H S B C BUSINESS SOLUTIONS COSTC
CARMEL, INDIANA 46032 PO BOX 17698
HECK AMOUNT: $29.93
BALTIMORE MD 21297-1698 CHECK NUMBER: 213479
CHECK DATE: 10/9/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4350100 069521 29 . 93 BUILDING REPAIRS & MA
COSTCO
® Please Direct Inquiries To: 1-800-220-8594
® YALE
Account Number New Balance Payment Due Amount Past Due Due Date
7003-7311-0007-4683 $29.93 $.00 $.00 10/21/2012
Billing Date Credit Line Available Credit
-- 09/26/2012 $2,000 $1,970.07
a: TDD/Hearing Impaired: 1-800.365-0186
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 Balance Payment Expire
Description Number Balance Rate APR Periodic Rate RATE Due
® Reg 00014 S1.93 0.00000% 00.00% 5.00 00.00% 529.93 S.00 10/26/2012
ACCOUNT DETAIL
® Transaction Transaction Invoice User P.O. Transaction
Date Description Number ID Number Amount
09/06/2012 COSTCO WHOLESALE-347 069521 00003 S29.93
00003 SUBTOTAL: S29.93
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On average,the garbage an American throws away in a year emits 1,060 pounds of carbon.
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
unauthorized 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.
COs TCO
ACCOUNT SUMMARY BALANCE SUMMARY
Outstandin
CURRENT 1-29 DAYS PAST DUE 30-59 DAYS PAST DUE Transaction g $.00
+New
$.00 $.00 Purchase(s)/Debit(s) $29.93
60-89 DAYS PAST DUE 90-119 DAYS PAST DUE 120-149 DAYS PAST DUE +New Fees $.00
-- +Finance Charges $.00
$.00 $.00 $.00
- Payments) $.00
150-179 DAYS PAST DUE 180+DAYS PAST DUE
® $.00 $.00 =New Balance $29.93
Page 2 of 2
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Please check box and complete reverse side.
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Important Notice:Promptly review this statement and notify HSBC Business Solutions in writing of any errors or
unauthorized 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(10/07)
TO ENSURE ACCURACY, PLEASE PRINT NEATLY USING UPPER-CASE LETTERS
AND NUMBERS ONLY!
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Email Address
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Street Numbe f a, Su,01 Nit, tl'e ,O,ds'PO BOX Unit or PO BOX Number
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city State zip
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Business Phone
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VOUCHER NO. WARRANT NO.
ALLOWED
HSBC Business Solutions
IN SUM OF $
P.O. Box 5219
Carol Stream, IL 60197-5219
$29.93
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Bo
1207 I 069521 43-501.00 I S29.93 I hereby certify that the a't'tached invoi
bill(s) is (are) true and correct and tha
materials or services itemized thereo
which charge is made were ordered
received except
Wednesday, Oc
Director, Brook ire Golf w
Title
fi
Cost distribution ledger classification if
claim paid motor vehicle highway fund
City Form No.201 (Rev. 1995)
20 ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
mized must show: kind of service, where performed, dates service rendered, by
�— lours, rate per hour, number of units, price per unit, etc.
Purchase Order No.
I Terms
IDate Due
Description Amount
rd Members (or note attached invoice(s) or bill(s))
e(s), or I Cleaning Products I $29.93
the
for
d
'.; ober 03, 2012
�J.
Club
ae(s), or bill(s), is (are) true and correct and I have audited same in accordance
Clerk-Treasurer