217022 02/13/2013 \.� CITY OF CARMEL, INDIANA VENDOR: 366015 Page 1 of 1
ONE CIVIC SQUARE WEX BANK CHECK AMOUNT: $270.74
'� CARMEL, INDIANA 46032 PO BOX 6293
CAROL STREAM IL 60197-6293 CHECK NUMBER: 217022
CHECK DATE: 2/13 12013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4231400 31914957 270 . 74 GASOLINE
I nvoice &atement
INVOICE NUMBER: 31914957
ro ACCOUNT NAME: City of Carmel Admin.
PAGE 1 OF 1
ACCOUNT NUMBER CREDIT LIMIT DAYS THIS PERIOD BILL CLOSING DATE PAYMENT DUE DATE AMOUNT DUE
0496-00.138002-1 1 550.00 31 JAN-31-2013 FEB-26-2013 270.74
DATE ACTIVITY DESCRIPTION CHARGES/DEBITS PAYMENTS/CREDITS
JAN-14-2013 PAYMENT-THANK YOU 256.97
JAN-31-2013 FUEL PURCHASES 270.74
REMINDER
REMINDER PLEASE BE SURE TO INCLUDE REMITTANCE STUB
WITH PAYMENT. MAIL TO THE ADDRESS SHOWN IN THE
RIGHT PORTION OF THE REMITTANCE STUB.
G 'z ; 1`I
I , `II
u
l
By
PURCHASES,RETURNSAND PAYMENTS MADE JUST PRIOR TO BILLING DATE MAY NOT APPEAR UNTIL THE NEXT INVOICEISTATEMENT,
PREVIOUS BALANCE PAYMENTS (,)PURCHASES (+)DEBITS CREDITS (,)LATE FE = NEW BALANCE
256.97 256.97 270.74 0.00 0.00 0.00 270.74
CALL CUSTOMER SERVICE TO PAY BY PHONE
FEDERAL TAX ID: 841425616 The Late Fee is determined by Which is an EFFECTIVE ANNUAL To the balance subject to late
applying it monthly rate of RATE of fee for this period which is
2.08 % 24.99 % 0.00
SEE REVERSE SIDE FOR IMPORTANT INFORMATION AND TERMS.
_________TQ)TNWRE_PROPER QREQIT-TEAf2 AT PERFQ RAT IONANDJ NQLUQE BOTTQM_PORTIQN WITH YQUR
PAYMENT.
ACCOUNT NAME City of Carmel Admin
ACCOUNT NUMBER 0496-00-138002-1 Circle K Fleet
INVOICE NUMBER 31914957
BILL CLOSING DATE JAN-31-2013 FAX CHANGE OF ADDRESS REQUEST TO 1-800.395-0809.
Make check payable to:WEX BANK.
AMOUNT DUE 270.74 Use eTdosed envelope or send to:
AMOUNT ENCLOSED
PAYMENT DUE DATE FEB-26-2013
PAYMENTS RECEIVED AFTER THIS DATE SUBJECT TO LATE FEES
AItIIttllttttttllLlttLttl,ILtttltlLlttttlltltttll
WEX BANK
P.O. BOX 6293
CAROL STREAM IL 60197-6293
WARRANT NO. Prescribed by State Board of Accounts cib
ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
ces
IN SUM OF$ CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service,where performed,dates servi
197-6293 whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
)270.74 Payee
Purchase Order No.
F APPROPRIATION FOR
Terms
ition Department
Date Due
Invoice Invoice Description
O. ACCT#/TITLE AMOUNT Board Members Date Number (or note attached invoice(s)or bill(s))
i7 42-314.00
I hereby certify that the attached invoice(s), or 01/31/13 31914957
$270.74
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
Monday, February 11, 2013
Director, Administration
Title
ledger classification if I hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited si
vehicle highway fund with IC 5-11-10-1.6
20
Clerk-Treast