Purchase Order Dentist in United States New York City –Free Word Template Download with AI
Official Procurement Document — Dental Practice Supply Acquisition
PO Number: NYC-DENT-2025-004872
Date of Issue: June 12, 2025
Valid Until: July 12, 2025
Buyer (Dentist / Dental Practice)
Dr. Margaret A. Sullivan, DDS
Sullivan & Associates Dental Group
1420 Broadway, Suite 850
New York, New York 10018
United States
Phone: (212) 555-0147
Email: [email protected]
NYC DCA License No. 48291
Supplier / Vendor
MedDent Supply Co., Inc.
780 Industrial Avenue
Long Island City, New York 11101
United States
Phone: (718) 555-0392
Email: [email protected]
Federal Tax ID: 12-3456789
NYC Business License: 2019-BL-77843
The following items are ordered by the Dentist, Dr. Margaret A. Sullivan, for use at the Sullivan & Associates Dental Group practice located in United States New York City. All items must comply with FDA regulations and NYC Department of Health and Mental Hygiene standards for dental equipment and materials.
| Item # | Description | SKU | Qty | Unit Price (USD) | Line Total (USD) |
|---|---|---|---|---|---|
| 1 | Digital Dental X-Ray Sensor (Sennsion 2D, 24x24mm) | MDX-2424-DIG | 2 | $4,850.00 | $9,700.00 |
| 2 | Composite Resin Restorative Material (3M Z350 XT, A2, 4x4g) | MDR-3M-Z350-A2 | 24 | $38.50 | $924.00 |
| 3 | Nitrile Examination Gloves (Medium, Box of 100) | MDG-NIT-M-100 | 50 | $12.75 | $637.50 |
| 4 | High-Speed Handpiece (NSK T104L, with 4 Bur Kits) | MDE-NSK-T104L | 3 | $1,240.00 | $3,720.00 |
| 5 | Autoclave Sterilization Cassettes (12x12x4 inches) | MDS-ACL-12124 | 10 | $89.00 | $890.00 |
| 6 | Intraoral Camera (5MP, LED Illuminated, USB-C) | MDC-IOC-5MP | 1 | $2,150.00 | $2,150.00 |
| 7 | Local Anesthetic Cartridges (Lidocaine 2% w/ Epinephrine 1:100K, 1.8mL) | MDA-LID-2-100K | 100 | $3.20 | $320.00 |
| 8 | Dental Impression Material (Polyvinyl Siloxane, Medium Viscosity, 340g) | MDS-PVS-MED-340 | 12 | $42.00 | $504.00 |
| 9 | LED Curing Light (1200 mW/cm², 10-Second Cure) | MDC-LED-1200 | 2 | $680.00 | $1,360.00 |
| 10 | Patient Dental Chair Covers (Disposable, 48x36 inches, 100-pack) | MDC-CHC-4836-100 | 6 | $54.00 | $324.00 |
Subtotal: $20,529.50
NYC Sales Tax (8.875%): $1,821.99
Shipping & Handling (NYC Metro): $185.00
Grand Total: $22,536.49
All items listed in this Purchase Order shall be delivered to the dental practice office of Dr. Sullivan at 1420 Broadway, Suite 850, New York, New York 10018, United States. Delivery must be completed no later than June 27, 2025. The supplier is responsible for arranging freight within the United States New York City metropolitan area. All dental equipment must be shipped in original manufacturer packaging with appropriate protective materials. The Dentist's office will be open for receiving between 8:00 AM and 5:00 PM, Monday through Friday. A signature from an authorized representative of the dental practice is required upon delivery. The supplier must provide a Bill of Lading and a copy of the completed Purchase Order acknowledgment with each shipment.
Payment for this Purchase Order shall be made via ACH bank transfer to the supplier's designated account. The total amount of $22,536.49 is due net thirty (30) days from the date of confirmed delivery and acceptance of all items by the Dentist. Late payments shall accrue interest at a rate of 1.5% per month. The supplier must issue a valid commercial invoice referencing Purchase Order number NYC-DENT-2025-004872. All payments are subject to the terms of the New York State Uniform Commercial Code (UCC) as applicable in the United States New York City jurisdiction.
- This Purchase Order constitutes a binding agreement between the Dentist (Buyer) and MedDent Supply Co., Inc. (Supplier) for the procurement of dental supplies and equipment for use in a licensed dental practice in United States New York City.
- All dental products must be FDA-cleared or FDA-approved and must meet the quality and safety standards established by the New York State Department of Health for dental practices operating in New York City.
- The Dentist reserves the right to inspect all delivered items within five (5) business days of receipt. Any items found to be defective, damaged, or not conforming to the specifications listed in this Purchase Order shall be returned at the supplier's expense and replaced within ten (10) business days.
- The supplier warrants that all equipment and materials are new, unused, and free from liens or encumbrances. Manufacturer warranties shall be transferred to the dental practice upon delivery.
- This Purchase Order is governed by the laws of the State of New York, United States. Any disputes arising from this Purchase Order shall be resolved in the state or federal courts located in New York County, New York City.
- The supplier shall maintain adequate liability insurance coverage of no less than $2,000,000 per occurrence for products delivered under this Purchase Order.
- Neither party may assign this Purchase Order without the prior written consent of the other party. This Purchase Order may not be modified except by a written amendment signed by both the Dentist and an authorized representative of the supplier.
- All personal health information and patient data associated with the dental practice in United States New York City shall remain confidential and shall not be disclosed to any third party in connection with the fulfillment of this Purchase Order.
- The supplier acknowledges that the dental practice operates under the jurisdiction of the New York City Department of Health and Mental Hygiene and the New York State Board of Dentistry, and all delivered items must comply with applicable local, state, and federal regulations.
Authorized by (Buyer / Dentist):
Dr. Margaret A. Sullivan, DDS
Sullivan & Associates Dental Group
Date: ____________________
Accepted by (Supplier):
Authorized Representative, MedDent Supply Co., Inc.
Name: ____________________
Date: ____________________
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