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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 />Stryker Terms and Conditions <br />www.stryker.com/stnc <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 />Docusign Envelope ID: 124C2255-EB5C-4E9B-9434-35BB530FD7EA <br />Lysa May <br />919-245-6152 <br />10964623 <br />Lysa May <br />10964623 <br />Hillsborough, NC 27278 <br />OCES <br />919-245-6152 <br />20159606 <br />lmay@orangecountync.gov <br />20190959 <br />919-245-6152 <br />510 Meadowlands Drive <br />Lysa May <br />510 Meadowlands Drive <br />OCES <br />Lysa May <br />336-213-1114 <br />Hillsborough NC 27278 <br />8/20/2024 <br />Travis Myren <br />Deputy County Manager