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DocuSign Envelope ID:310A4076-3F71-410D-97E4-ED2CCF234171 <br /> Purchase Order Form stryker� <br /> Account Manager Purchase Order Date <br /> Cell Phone Expected Delivery Date <br /> Stryker Quote Number 210217110023 <br /> Check box if Billing same as Shipping 171 <br /> BILLTO CUSTOMER# SHIP TO CUSTOMER# <br /> Billing Account Num 1155990 Shipping Account Num 1284548 <br /> .............................................................................................................................................................................. ..................................................................................................................................................................... <br /> Company Name Company Name ORANGE COUNTY EMER MGMT <br /> .............................................................................................................................................................................. ..................................................................................................................................................................... <br /> Contact or Department Contact or Department Kim Woodard <br /> .............................................................................................................................................................................. ..................................................................................................................................................................... <br /> Street Address Street Address 510 MEADOWLANDS DR <br /> .............................................................................................................................................................................. ..................................................................................................................................................................... <br /> Addt'I Address Line Addt'I Address Line <br /> .............................................................................................................................................................................. ..................................................................................................................................................................... <br /> City,ST ZIP City,ST ZIP HILLSBOROUGH,NC 27278-8504 <br /> .............................................................................................................................................................................. ..................................................................................................................................................................... <br /> Phone Phone <br /> Authorized Customer Initials Authorized Customer Initials <br /> DESCRIPTION QTY TOTAL <br /> REFERENCE QUOTE <br /> Accounts Payable Contact Information <br /> Lysa May <br /> Name <br /> Email lmayCaorangecountync.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 Il`tsje—Mnage r <br /> Signature <br /> Date <br /> Attachment Stryker Quote Number 210217110023 <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 />