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Purchase Order Form <br />Account Manager <br />Cell Phone <br />Check box if Billing same as Shipping <br />BILL TO <br />!!,!,lling Account Num <br />�<;>mpany Name ,.. Contact or Department ,..., Street Address r' Addt'I Address Line ""' City, ST ZIP .. , Phone <br />Authorized Customer Initials <br />DESCRIPTION <br />REFERENCE QUOTE 1.._ ___ _,1 <br />□ <br />CUSTOMER# <br />Accounts Payable Contact Information <br />Name <br />Email <br />Phone <br />Authorized Customer Signature <br />Printed Name <br />Title <br />Signature <br />Date <br />Attachment Stryker Quote Number <br />·-·- <br />·-·- <br />QlY <br />I I <br />stryker® <br />SHIP TO <br />Purchase Order Date <br />Expected De livery Date <br />Stryker Quote Number <br />��ipping Account Num <br />$.ompany Name <br />�.ontact or De partment Street Address <br />Addt'I Address Line .... ,S:,itv, ST ZIP <br />Phone <br />Authorized Customer Initials <br />TOTAL <br />CUSTOMER# I <br />Service Terms and Conditions: <br />The Terms and Conditions attached to this quote (modified between the parties as of March 2024) govern this quote and any subsequent purchase order of customer. <br />The terms and conditions referenced in the immediately preceding sentence do not apply where Customer and Stryker are parties to a Master Service Agreement. <br />·-·-·-·-·- <br />*Sales or use taxes on domestic (USA} deliveries will be invoiced in addition to the price of the goods and services on the Stryker Quote. <br />ACCOUNTS PAYABLE <br />ACCOUNTSPAYABLE@EVERETTWA.GOV <br />Cassie Franklin <br />Mayor <br />03/25/2024