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DocuSign Envelope ID: D928996A-68DE-4E98-AF2F-35B2845B2207 <br /> Purchase Order Form stryker <br /> Account Manager Purchase Order Date <br /> Cell Phone Expected Delivery Date <br /> Stryker Quote Number 210212134628 <br /> Check box if Billing same as Shipping ❑ <br /> BILL TO CUSTOMER# SHIP TO CUSTOMER# <br /> Billing Account Num 1155990 Shipping Account Num 1284548 <br /> .................................................................................. ......................................... ......................................... .................................................................................................................................................................... <br /> Company Name range ountyEmergency ervices Company Name ORANGE COUNTY EMER MGMT <br /> .............................................................................................................................................................................. .................................................................................................................................................................... <br /> Contact or Department Attention;.Lysa.May Contact or Department Kim Woodward <br /> ........................................................... ........................................................................................................... .................................................. <br /> Street Address PO Box 8181 Street Address 510 MEADOWLANDS DR <br /> .................................................................................................................................................................. <br /> Addt'I Address Line IAc. <br /> Address Line <br /> .............................................................................................................................................................................. ............................................................rL1SBOROUGH,.NC <br /> ... ............................................................................................... <br /> City,ST2IP City,STZIP..................................... I 27278-8504................................................................................................H .1.sb.9x.Q11gh,.N.G�7..2.7.8................................................... ............ <br /> one 919-245-6152 Phone 19-245-6152 <br /> DSSI DS <br /> Authorized Customer Initials �" Authorized Customer Initials <br /> DESCRIPTION QTY TOTAL <br /> REFERENCE QUOTE 210212134628 $33,415.2 <br /> Accounts Payable Contact Information <br /> Name Lysa May <br /> Email lmay@orangecountync.gov <br /> Phone 919-245-6152 Stryker Terms and Conditions <br /> www.strykeremergencycare.com/terms <br /> Authorized Customer Signature <br /> Printed Name Bonnie Hammersl ey <br /> Title Co nyn age ra <br /> Signature <br /> Date <br /> Attachment Stryker Quote Number 210212134628 <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 />