24634 CTL Scientific SupplyCi
of C<•l rme1
ONE CIVIC SQUARE
CARMEL, INDIANA 46032 -2584
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL - 1997
INDIANA RETAIL TAX EXEMPT
CERTIFICATE NO. 003120155 002 0
FEDERAL EXCISE TAX EXEMPT
35- 60000972
PAGE
N
PURCHASE ORDER NUMBER
24634
THIS NUMBER MUST APPEAR ON INVOICES, AN
VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
PURCHASE ORDER DATE
DATE REQUIRED
REQUISITION NO.
VENDOR NO.
DESCRIPTION
9/3021114
`
CONTRACT
Nc�N--S�_ , — — A -�
VENDOR
CTL Scientific Supply Corp .
1016-3 Grand Boulevard
Deer Park, NY 11729
SHIP
TO
Cannel Fire Department
2 Carmel Civic Square
Cannel, IN 46032
(317) 571 -2622
CONFIRMATION
BLANKET
PAYMENT TERMS
FREIGHT
`
CONTRACT
QUANTITY \I HI* MEASURE I
- DESCRIPTION I UNIT PRICE
I
EXTENSION
)
Account 102-670 -04.
1 Each HM -100 Test Strips
1 Each Shipping
Send Invoice To:
Cannel Fire Department
2 Cannel Civic Square
Cannel, IN 46032-
PLEASE INVOICE IN DUPLICATE
$56.50
$10.00
Sub Total:
$56.50
$10.00
$66.50
DEPARTMENT
ACCOUNT
PROJECT
PROJECT ACCOUNT
AMOUNT
Cannel Fire Department
SHIPPING INSTRUCTIONS
• SHIP REPAID.
• C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
• PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS.
• THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
24634
DOCUMENT CONTROL NO.
PAYMENT -- $66.50
• NP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
• I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
ORDERED BY��� -�_
TITLE
CLERK - TREASURER
OFFICE COPY