221183 06/18/2013 CITY OF CARMEL, INDIANA VENDOR: 367042 Page 1 of 1
` ONE CIVIC SQUARE PAPERLESS BUSINESS SYSTEMS
a CARMEL,INDIANA 46032 1417 FOURTH AVE,4TH FLOOR CHECK AMOUNT: $5,120.00
SEATTLE WA 98101 CHECK NUMBER: 221183
CHECK DATE: 6/18/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4463202 S004848 2 , 560 . 00 SOFTWARE
1091 4463202 S004848 2 , 560 . 00 SOFTWARE
Invoice
poperless
business systems
1417 Fourth Avenue,4th Floor Invoice Number SO-04848
Seattle,WA 98101 Invoice Date 5/29/2013
p 206.256.0771 Purchase Order 29860
f 206.282.3312 Customer Number CACL001
SOLD TO: SHIP TO
Carmel Clay Parks& Recreation Carmel Clay Parks& Recreation
Attention: Accounts Payable RF Attention: Accounts Payable
1411 E 116th Street 1411�'` �', � 1411 E 116th Street
Carmel, IN 46032 MAY 3 12013 Carmel, IN 46032
may:—
SALES ORDER TERMS PBS CONTACT
SO-04848 30 days of receipt Accounts Receivable
Description Amount
eRequester Custom Order
Customization Al -Custom PO Forms 5,120.00
Purchase C)Lksto IM p.(]
7711 Di; •arip�i;on_ '�Y y�L."Po v�
P.O.
rl h h r.L.# X _ E�- `t`i Ie3 2.o J
v I =
2,��a• v V Line Descr
5 I^O M Purchaser Date
Ot •lv Approval ,' Date wI
A 1%3%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 Avenue, 4th Floor, Seattle, WA 98101
p 206.256 0769 f 206 282.3312 www.paperlessbusiness corn info @paperlessbusiness.com TOTAL AMOUNT USD $5,120.00
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
5/29/13 S004848 Custom P.O. form for software 29860 $ 2,560.00
5/29/13 S004848 Custom P.O. form for software 29860 $ 2,560.00
Total $ 5,120.00
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
Voucher No. Warrant No.
367042 Paperless Business Systems Allowed 20
1417 Fourth Avenue, 4th Floor
Seattle, WA 98101
In Sum of$
$ 5,120.00
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE/ 109 MCC
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-99 S004848 4463202 $ 2,560.00 1 hereby certify that the attached invoice(s), or
1091 S004848 4463202 $ 2,560.00 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
13-Jun 2013
Signature
$ 5,120.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund