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Qty Manufacturer Item Code Description Retail Price Price Total <br />Subtotal: <br />Shipping & Handling: <br />ESTIMATED TAX: <br />Total: <br />Deposit: <br />Balance Due: <br />QUOTE# <br />Date: Acct No: Estimated Install Date: <br />Field Sales Consultant: Sales Specialist: Sales Specialist: <br />Installation Address: <br />Bill To: City: State: Zip: <br />Address: Phone: Fax: <br />City: State: Zip: <br />Deliver To: Henry Schein Dental <br />Phone: <br />Fax: City: State: Zip: <br />Email: Phone: Fax: <br />Special Instructions <br />Page {CurrentPage} of {TotalPages} <br />terms <br />APPLIED CUSTOMER <br />DISCOUNT: <br />Address: <br />X X Purchaser’s Signature Date Sales Specialist Date <br />Prices are in effect until Acceptance by Henry Schein Dental Date <br /> Payment Terms: Minimum 10% deposit required to initiate order (excluding government customers). Balance to be paid on delivery, and Customer must take delivery within three months of Estimated Install Date above. Excluding applicable terms from other applicable contract. <br />THIS ORDER IS SUBJECT TO HENRY SCHEIN DENTAL EQUIPMENT TERMS AND CONDITIONS AND ANY SUPPLEMENTAL TERMS AND <br />CONDITIONS PROVIDED WITH PURCHASES HEREUNDER, AND THE PURCHASER AGREES TO BE BOUND THEREBY. <br />Orders are subject to credit approval. <br />For dental radiation-emitting equipment, the National Council on Radiation Protection (NCRP) recommends, and many states require, a shielding design/plan review performed by a <br />qualified expert before installation. As a service, HSD will obtain this from a qualified expert on your behalf; applicable fees will be added to your order. <br />If you are in a state that does not require this, and decline this service, please check the box and sign here. Decline Customer Signature_____________________________________ <br />Equipment Deposits <br />PO Box 360920 <br />Pittsburgh, PA 15251-6920 <br />Correspondence <br />135 Duryea Road <br />Melville, NY 11747 <br />Order Type: <br />05/21/2025 555072 06/27/2025 <br />Emily Farrell <br />300 W Tryon St <br />Orange County Health Dept Hillsborough NC 27278 <br />300 W Tryon St 9192452466 <br />Hillsborough NC 27278 <br />Orange County Health Dept <br />9192452466 <br />(919) 740-5753 <br />1 AIRTEC 698-9254 Vacstar 50 Twin Pump Sytsm $9,095.00 $5,855.68 $5,855.68 <br />1 $0.00 $0.00 $0.00 <br />[optional extended warranty] <br />1 AMTRUS 128-6526 ExtServ WVAC 10yr 5- 6K - $1100 $1,100.00 $1,100.00 $1,100.00 <br />1 Wet Vacuum Extended Service:$0.00 $0.00 $0.00 <br />1 Henry Schein Protect Commercial Service $0.00 $0.00 $0.00 <br />1 Contract. Please review applicable terms $0.00 $0.00 $0.00 <br />1 and conditions attached to your proposal $0.00 $0.00 $0.00 <br />1 or at henryschein.com/protect for full $0.00 $0.00 $0.00 <br />1 coverage details. Please note certain $0.00 $0.00 $0.00 <br />1 exclusions apply-including but not limited $0.00 $0.00 $0.00 <br />1 to:preventative maintenance/consumables $0.00 $0.00 $0.00 <br />1 /rentals/ negligence/ intentional or $0.00 $0.00 $0.00 <br />1 accidental damage. For more information $0.00 $0.00 $0.00 <br />1 please contact protect@henryschein.com $0.00 $0.00 $0.00 <br />1 $0.00 $0.00 $0.00 <br />1 no deposit req w/PO $0.00 $0.00 $0.00 <br />$153.03 <br />$533.16 <br />$7,641.87 <br />$0.00 <br />$7,641.87 <br />$6,955.68 <br />202505212122001 <br />1 of 1 <br />$3,239.32 <br />emily.farrell@henryschein.com <br />05/30/2025 <br />Docusign Envelope ID: A6A79380-F992-4605-AD65-69E9820B20A1