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CITY <br /> Bel levue Healthcare IITH DELIVERY TICKET <br /> Date 51820188:48:55 AM <br /> www . bellevuehealthcare . com � <br /> Sales Order 820952 <br /> 2031 Broadway,Everett, WA 98201-2317, Phone: (425) 258-6700 Customer ID 262226 <br /> Customer City of Everett Cultural Department, DOB 01/01/2000 Height Weight Sex M <br /> Bill to 2930 Wetmore Ave Deliver to 2930 Wetmore Ave <br /> Suite 10-A Suite 10-A <br /> Everett, WA 98201 Everett, WA 98201 <br /> (425) 257-7117 (425) 257-7117 <br /> Insurance None Referral <br /> Comments or Special Instructions HIPAA Signature on file No <br /> -6 manual wheelchairs being loaned to the City of Everett Cultural Department for the 4th of July Festival. Chairs to be picked up in <br /> store on Tuesday the 3rd and returned Thursday the 5th. <br /> -POC is Delaney Morris at 425-257-7117. <br /> Delivery Date Time CSR Branch <br /> 7/3/2018 Brent x8746 Everett <br /> Qty I UOM Type Bin Item Ext. Amt. 1 Tax I Co-Pay <br /> Warehouse Everett <br /> 1 Rental 12-06 RR WC SX5 Ltwght/Wheelchair SX5 Lightweight(Specify Size) $0.00 $0.00 $0.00 <br /> 16x16 <br /> Serial No. Asset No. <br /> 1 Rental 12-06 RR WC SX5 Ltwght/Wheelchair SX5 Lightweight(Specify Size) $0.00 $0.00 $0.00 <br /> 18x16 <br /> Serial No. Asset No. <br /> 1 Rental 12-06 RR WC SX5 Ltwght/Wheelchair SX5 Lightweight(Specify Size) $0.00 $0.00 $0.00 <br /> 18x16 <br /> Serial No. Asset No. <br /> 1 Rental 12-06 RR WC SX5 Ltwght/Wheelchair SX5 Lightweight(Specify Size) $0.00 $0.00 $0.00 <br /> 18x16 <br /> Serial No. Asset No. <br /> 1 Rental 12-06 RR WC SX5 Ltwght/Wheelchair SX5 Lightweight(Specify Size) $0.00 $0.00 $0.00 <br /> 20x16 <br /> Serial No. Asset No. <br /> 1 Rental 12-06 RR WC SX5 Ltwght/Wheelchair SX5 Lightweight(Specify Size) $0.00 $0.00 $0.00 <br /> 20*16 <br /> Serial No. Asset No. <br /> TOTAL $0.00 $0.00 $0.00 <br /> 1111111111111111111111 IIII IIII I I Sales 9 <br /> Customer City of2Customer262226 <br /> Everett Cultural al Department, Pae 1 of 2 <br /> 1126511858371 g <br />