26533 Crossroad EngineersCi of Carmel
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
PURCHASE ORDER NUMBER
THIS NUMBER MUST APPEAR ON INVOICES, AP
VOUCHER. DELIVERY MEMO. PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
''.
PURCHASE ORDER DATE
DATE REQUIRED
REQUISITION NO.
VENDOR NO.
DESCRIPTION
CI1C\t2-
VENDOR ✓CC
SHIP
TO
. Dr C ,nS, „tvg _ , As
CQNFIRMATION BLANKET CONTRACT
PAYMENT TERMS
FREIGHT
QUANTITY
UNIT-OF MEASURE 1
DESCRIPTION
UNIT PRICE
EXTENSION
Send Invoice To:
/k 3
PLEASE INVOICE IN DUPLICATE
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DEPARTMENT
ti
ACCOUNT
PROJECT
I PROJECT ACCOUNT
AMOUNT
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.
DOCUMENT CONTROL NO. 2655 33
ORDERED BY
TITLE
CLERK - TREASURER
OFFICE COPY
PAYMENT
• AP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE PO.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
• I HEREBY CERTIF/ THAT THERE IS AN UNOBLIGATED BALANCE IN
THIS APPROPRIATI _ IENT TO PAY FO •TFIE ABOVE ORDER.