220740 06/04/2013 CITY OF CARMEL, INDIANA VENDOR: 367042 Page 1 of 1
ONE CIVIC SQUARE PAPERLESS BUSINESS SYSTEMS
CARMEL, INDIANA 46032 1417 FOURTH AVE,4TH FLOOR CHECK AMOUNT: $784.94
o� SEATTLE WA 98101 CHECK NUMBER: 220740
CHECK DATE: 6/4/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4355200 PF404681 392 .47 SUBSCRIPTIONS
1091 4355200 PF404681 392 .47 SUBSCRIPTIONS
r
Invoicee,
paper Iess
business systems Z;xmiit?4 ' xr1:°�
1417 Fourth Ave.4th Floor Invoice Number PF4-04681
Seattle,WA 98101 Invoice Date 5/16/2013
p 206.256 0771
f 206.282.3312 Purchase Order 29557
Customer Number CACL001
SOLD TO. SHIP TO
Carmel Clay Parks&Recreation Carmel Clay Parks& Recreation
Attention: Accounts Payable Attention: Accounts Payable
1411 E 116th Street TFD 1411 E 116th Street
Carmel, IN 46032 MAY 2 0 2013 Carmel, IN 46032
2_Y:—
TERMS -- - — —� PBS CONTACT
Net 30 Accounts Receivable
Description Amount
eRequester Hosted Subscription (SAAS)
Hosting Period: month 4 of 12, 6/28/13-7/27/13
eRequester Hosting for 50 Named Users 713 55
Hosted Receiving Module 16465
Monthly Discount for 1st Year -93 26
Purchase
D:-:>cription —lcellse `t
P.O.# aCN 5'x-7 onF
G.L.# 1081 -q9 - �355aoO Sci2.4-7
R daet
i-lneDescr 455-5000 392.y�
Purchaser Date
Approval Date .q t--}
Invoice is due within thirty(30)days of receipt
A 11/2%monthly charge is payable on all overdue balances
The grant of any license or right is conditioned on receipt of full payment
All payments and dollar amounts are in U.S.Dollars.
Remit to: Paperless Business Systems, Inc.
1417 Fourth Ave, 4th Floor, Seattle, WA 98101
p 206.256.0769 f 206 282.3312 www paperiessbusiness com info @paperlessbusiness.com TOTAL AMOUNT USD $784.94
Wire Information: Swift#BOFAUS3N Bank of America,WA3-177-01-01
Bank Name:Bank of America Routing# 125000024 408 Pike St.Seattle,WA 98101
ABA#026009593 Account#. 138019775709(savings)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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
367042 Paperless Business Systems Terms
1417 Fourth Avenue, 4th Floor
Seattle, WA 98101
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO # Amount
5/16/13 PF404681 Purchasing license software Jun'13 29557 $ 392.47
5/16/13 PF404681 Purchasing license software Jun'l3 29557 $ 392.47
Total $ 784.94
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
L
Voucher No. Warrant No.
367042 Paperless Business Systems Allowed 20
1417 Fourth Avenue, 4th Floor
Seattle, WA 98101
In Sum of$
$ 784.94
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE / 109 MCC
PO#or Board Members
Dept#
INVOICE NO. ACCT#/TITL AMOUNT
1081-99 PF404681 4355200 $ 392.47 1 hereby certify that the attached invoice(s), or
1091 PF404681 4355200 $ 392.47 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
30-May 2013
Signature
$ 784.94 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund