26471 Midwest Sign Associationof 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, AT
VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE'
PURCHASE ORDER DATE
DATE REQUIRED
REQUISITION NO.
_ VENDOR NO.
DESCRIPTION
1ildia-
VENDOR
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SHIP 7�� 0
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CONFIRMATION
BLANKET
CONTRACT
PAYMENT TERMS
FREIGHT
QUANTITY I UNIT OF MEASURE
DESCRIPTION
UNIT PRICE
EXTENSION
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Send Invoice To: IJ$4 CI. 5� � 9
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PLEASE INVOICE IN DUPLICATE
DEPARTMENT
ACCOUNT
PROJECT
PROJECT ACCOUNT
AMOUNT
SHIPPING INSTRUCTIONS
• SHIP REPAID.
• C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
• PURCHASE OHOF.R NUMBER MUST APPEAR ON ALL
SHIPPING LABELS.
• TIES ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99. ACTS 1945
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
DOCUMENT CONTROL NO. 26471
ORDERED BY
TITLE
CLERK - TREASURER
PAYMENT
• NP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.Q.
NUMBER 15 MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
• 1 HEREBY CERTIFY THAT THERE 15 AN1UNOULIGATED BALANCE IN
THIS APPROPRIATION SUFFICIENT TTOO PAY FOR THE ABOVE ORDER.
A.P.V. COPY - SIGN AND RETURN TO CLERK'S OFFICE
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