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Purchase Order Dentist in United States San Francisco –Free Word Template Download with AI

Bay Area Dental Supply & Equipment Co.

1450 Market Street, Suite 820, San Francisco, California 94102, United States

Tel: (415) 555-0198 | Email: [email protected]

PO No. SF-2025-04872
Field Information
Purchase Order Number SF-2025-04872
Date of Issue June 12, 2025
Required Delivery Date July 15, 2025
Payment Terms Net 30 days from date of invoice
Currency United States Dollars (USD)
Shipping Method Freight prepaid, delivered to San Francisco, United States
Incoterms DDP (Delivered Duty Paid) – San Francisco, California
Field Information
Practice Name Golden Gate Dental Associates
Principal Dentist Dr. Margaret Chen, DDS, MSD – Lead Dentist & Practice Owner
Address 2200 Fillmore Street, Suite 310, San Francisco, California 94115, United States
Phone (415) 555-7743
Email [email protected]
CA Dental Board License CA-D-184729
Federal Tax ID (EIN) 94-XXXXXXX
Field Information
Company Name Pacific Dental Distribution LLC
Address 8800 International Blvd, Oakland, California 94621, United States
Contact Person Robert Tanaka, Regional Sales Director
Phone (510) 555-3321
Email [email protected]
Federal Tax ID (EIN) 94-XXXXXXX

The following items are ordered by the Dentist at Golden Gate Dental Associates for use in the San Francisco, United States practice. All products must comply with FDA regulations and California State Board of Dentistry standards.

Item # Description SKU / Part No. Qty Unit Price (USD) Line Total (USD)
1 Digital Dental X-Ray Sensor (Intraoral, 2.0 MP) – for the Dentist's diagnostic imaging suite DXS-2000 2 $4,850.00 $9,700.00
2 LED Dental Operating Light, 50,000 Lux, with UV-C Sterilization Module LED-50K-UV 1 $3,200.00 $3,200.00
3 Composite Resin Filling Material, A2 Shade, 40g Syringes (Case of 12) CR-A2-40G 6 $185.00 $1,110.00
4 Nitrile Examination Gloves, Powder-Free, Size M (Box of 100) NG-M-100 50 $12.50 $625.00
5 Autoclave Sterilization Cycles – 15L Capacity, Class B, with Digital Timer AC-15L-B 1 $7,400.00 $7,400.00
6 Dental Handpiece, High-Speed Turbine, 400,000 RPM, with 3 Cartridges HS-400K-3C 4 $1,120.00 $4,480.00
7 Patient Dental Chair, Reclining, with Built-in Suction & Water Line DC-RL-WS 1 $12,500.00 $12,500.00
8 Prophylaxis Paste, Mint Flavor, 500g Jars (Case of 10) PP-M-500 4 $48.00 $192.00
9 Disposable Dental Burs, Carbide, Cross-Cut, Assorted (Pack of 500) DB-CC-500 3 $95.00 $285.00
10 Intraoral Camera, 1080p HD, with Wireless Foot Pedal & Software License IOC-1080-W 1 $2,850.00 $2,850.00
Subtotal $42,342.00
California Sales Tax (8.5%) $3,599.07
Freight & Delivery to San Francisco, United States $485.00
GRAND TOTAL (USD) $46,426.07
  1. Delivery: All items listed in this Purchase Order shall be delivered to the Dentist's practice location at 2200 Fillmore Street, San Francisco, California 94115, United States. Delivery must be completed no later than July 15, 2025. The supplier is responsible for all shipping, handling, and insurance costs within the United States.
  2. Quality Assurance: All dental equipment and materials must be new, unused, and in original manufacturer packaging. The Dentist reserves the right to inspect all items upon arrival. Any defective, damaged, or non-conforming goods must be reported within five (5) business days of delivery, and the supplier shall replace or refund the affected items at no additional cost.
  3. Regulatory Compliance: All products must be FDA-cleared or FDA-approved and must meet the standards set forth by the California State Board of Dentistry. The supplier warrants that all items comply with applicable federal and state regulations in the United States, including California Health and Safety Code provisions governing dental practice in San Francisco.
  4. Payment: Payment of the full Purchase Order amount of $46,426.07 USD shall be made via ACH bank transfer within thirty (30) calendar days of the supplier's invoice date. Late payments shall accrue interest at a rate of 1.5% per month.
  5. Warranty: The supplier guarantees a minimum of two (2) years of manufacturer warranty on all capital equipment (Items 1, 2, 5, 6, 7, and 10). Consumable supplies (Items 3, 4, 8, and 9) carry a standard 90-day defect warranty.
  6. Installation & Training: The supplier shall provide on-site installation of the dental chair, autoclave, X-ray sensors, and intraoral camera at the San Francisco, United States practice location. A minimum of four (4) hours of hands-on training for the Dentist and two (2) assistant staff members shall be included at no additional charge.
  7. Cancellation: This Purchase Order may be cancelled in whole or in part by the Dentist with written notice up to fourteen (14) days prior to the scheduled delivery date. Cancellations after this period are subject to a 15% restocking fee on non-consumable items.
  8. Governing Law: This Purchase Order shall be governed by and construed in accordance with the laws of the State of California, United States. Any disputes arising from this Purchase Order shall be resolved through binding arbitration in San Francisco, California, in accordance with the rules of the American Arbitration Association.
  9. Confidentiality: Both parties agree to maintain the confidentiality of all business information exchanged in connection with this Purchase Order, including pricing, patient-related data, and practice operational details specific to the San Francisco, United States dental practice.
  10. Force Majeure: Neither party shall be liable for delays or failures in performance resulting from events beyond reasonable control, including but not limited to natural disasters, pandemics, government-mandated closures, or supply chain disruptions affecting delivery within the United States.

By signing below, the undersigned parties acknowledge and agree to all terms, conditions, and line items specified in this Purchase Order for dental goods and services to be delivered in San Francisco, United States.

For the Buyer (Dentist / Practice Owner):

Name: Dr. Margaret Chen, DDS, MSD
Title: Lead Dentist & Owner, Golden Gate Dental Associates
Signature: ______________________________
Date: ______________________________
For the Supplier:

Name: Robert Tanaka
Title: Regional Sales Director, Pacific Dental Distribution LLC
Signature: ______________________________
Date: ______________________________

This Purchase Order (SF-2025-04872) was issued by Golden Gate Dental Associates, a licensed dental practice operating in San Francisco, California, United States. This document constitutes a binding agreement between the Dentist (Buyer) and Pacific Dental Distribution LLC (Supplier) for the procurement of dental equipment, instruments, and consumable supplies. All transactions are conducted in United States Dollars (USD) and are subject to California state and federal tax regulations.

Document generated: June 12, 2025 | Version 1.0 | Page 1 of 1

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