Purchase Order Dentist in Belgium Brussels –Free Word Template Download with AI
PO No: BB-2025-04871
Dental Practice Procurement — Brussels, Belgium
Date of Issue: 14 June 2025
Buyer (Dentist / Dental Practice)
Dr. Marie Van den Berghe, DDS
Clinique Dentaire du Parc
Avenue Louise 245, 1050
Brussels, Belgium
VAT No: BE 0765.432.109
Phone: +32 2 512 3456
Email: [email protected]
Supplier
MediDent Supplies NV
Industriepark 18, 1110
Brussels, Belgium
VAT No: BE 0812.567.432
Phone: +32 2 789 0123
Email: [email protected]
| Reference | Detail |
|---|---|
| Purchase Order Number | BB-2025-04871 |
| Order Date | 14 June 2025 |
| Required Delivery Date | 28 June 2025 |
| Delivery Address | Clinique Dentaire du Parc, Avenue Louise 245, 1050 Brussels, Belgium |
| Payment Terms | Net 30 days from invoice date, bank transfer (IBAN: BE68 5390 0754 7034) |
| Currency | Euro (EUR) |
| Incoterms | DDP (Delivered Duty Paid) — Brussels, Belgium |
| Item No. | Description | Qty | Unit | Unit Price (EUR) | Total (EUR) |
|---|---|---|---|---|---|
| 01 | Dental composite resin, A2 shade, 40g syringe (3M Filtek Z350) | 24 | pcs | 42.50 | 1,020.00 |
| 02 | Disposable nitrile examination gloves, size M, box of 100 | 50 | boxes | 18.90 | 945.00 |
| 03 | Intraoral digital camera sensor, 5-megapixel (Satelec OptraSensor) | 1 | unit | 3,850.00 | 3,850.00 |
| 04 | High-speed dental handpiece, 400,000 RPM, with turbine cartridge | 2 | units | 620.00 | 1,240.00 |
| 05 | Sodium hypochlorite 5.25% solution, 1L bottle (endodontic irrigant) | 30 | bottles | 12.75 | 382.50 |
| 06 | Dental impression material, polyvinyl siloxane, medium viscosity, 330ml cartridge | 40 | cartridges | 28.40 | 1,136.00 |
| 07 | LED curing light, 1,200 mW/cm², with 4 tips (Woodpecker E10) | 1 | unit | 485.00 | 485.00 |
| 08 | Autoclave sterilization pouches, 150mm x 250mm, pack of 200 | 20 | packs | 22.60 | 452.00 |
| 09 | Dental burs, carbide, round, size 2, 100 pcs per box | 5 | boxes | 34.00 | 170.00 |
| 10 | Patient dental chair headrest covers, disposable, box of 500 | 10 | boxes | 15.80 | 158.00 |
| Subtotal (excl. VAT) | 9,838.50 | ||||
| VAT — 21% (Belgian standard rate) | 2,066.09 | ||||
| GRAND TOTAL (incl. VAT) | 11,904.59 | ||||
All prices are in Euro (EUR). VAT is applied at the Belgian standard rate of 21% as per the Belgian Federal Tax Authority (SPF Finances / FOD Financiën) regulations applicable in Brussels, Belgium.
- This Purchase Order is issued by the above-named Dentist and dental practice located in Brussels, Belgium, and constitutes a binding request for supply of the listed dental materials and equipment.
- The Supplier shall deliver all items to the specified address in Brussels, Belgium, no later than the Required Delivery Date stated in Section 2. Late delivery beyond five (5) business days entitles the Buyer to cancel this Purchase Order without penalty.
- All dental products must comply with the European Union Medical Devices Regulation (EU) 2017/745 and carry a valid CE marking. The Supplier warrants that all items are new, unused, and within their stated shelf life.
- Payment shall be made within thirty (30) calendar days of receipt of a correct invoice, via bank transfer to the IBAN specified above. The Buyer reserves the right to withhold payment in the event of non-conforming goods.
- The Supplier shall provide a commercial invoice referencing this Purchase Order number (BB-2025-04871) and the applicable Belgian VAT identification number.
- In the event of a dispute arising from this Purchase Order, the parties agree to seek amicable resolution first. Failing resolution within thirty (30) days, the matter shall be submitted to the competent commercial court of Brussels, Belgium, and governed by the laws of the Kingdom of Belgium.
- The Dentist (Buyer) reserves the right to inspect all delivered goods upon arrival at the Brussels practice premises. Any damaged, defective, or incorrect items must be reported within five (5) business days of delivery, and the Supplier shall replace or refund such items at no additional cost.
- This Purchase Order is valid for acceptance within ten (10) business days from the date of issue. Acceptance is confirmed by the Supplier's written acknowledgment or by delivery of the goods.
- All personal data processed in connection with this Purchase Order shall be handled in accordance with the General Data Protection Regulation (GDPR) and the Belgian Data Protection Act of 30 July 2018.
For and on behalf of the Buyer (Dentist)
Dr. Marie Van den Berghe, DDSClinique Dentaire du Parc
Brussels, Belgium
Date: _______________
For and on behalf of the Supplier
MediDent Supplies NVAuthorised Representative
Brussels, Belgium
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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