26542 First Group Engineering, Incof Carmel
ONE CIVIC SQUARE
CARMEL, INDIANA 46032 -2584
FORM APPROVED BY STATE BOARLLOF 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
2.CDC92_
THIS NUMBER MUST APPEAR ON INVOICES. A/P
VOUCHER, DELIVERY MEMO. PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE,
PURCHASE ORDER DATE
DATE REQUIRED
REQUISITION NO.
VENDOR NO.
DESCRIPTION
VENDOR
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CONFIRMATION
BLANKET
CONTRACT
PAYMENT TERMS
FREIGHT
QUANTITY
UNIT OF MEASURE
DESCRIPTION
UNIT PRICE
EXTENSION
Send Invoice To:
DEPARTMENT
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PLEASE INVOICE IN DUPLICATE (QcNti'CpC Vpa - 2,M=g3-)
ACCOUNT
PROJECT
PROJECT ACCOUNT
AMOUNT
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SHIPPING INSTRUCTIONS
• SHIP.REPAID.
• 0 0 D. SHIPMENTS CANNOT RE ACCEPTED.
• PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS.
• THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99. ACTS 1945
AND ACT$ AMENDATORY THEREOF AND SUPPLEMENT THERETO.
DOCUMENT CONTROL NO: 26 5 4 2
ORDERED BY
TITLE
CLERK - TREASURER
OFFICE COPY
PAYMENT
• NP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OE THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
I HEREBY CERTIFY THAT THERE 15 AN UNOBLIGATED BALANCE IN
THIS APPROPRIATLCN SUFFICIENT TO PAY FORE ORDER.
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