Purchase Order Optometrist in Belgium Brussels –Free Word Template Download with AI
Brussels Optical & Vision Centre BV
124 Rue de la Loi, 1040 Brussels, Belgium
VAT No.: BE 0765.432.109 | Phone: +32 2 555 0147 | Email: [email protected]
Optometrist Procurement Division
| Supplier Name: | OptiVision Belgium SRL |
| Address: | 56 Avenue Louise, 1050 Brussels, Belgium |
| VAT No.: | BE 0812.765.432 |
| Contact Person: | Dr. Annelise Vermeulen, Lead Optometrist & Account Manager |
| Phone: | +32 2 774 8821 |
| Email: | [email protected] |
| Company: | Brussels Optical & Vision Centre BV |
| Receiving Address: | 124 Rue de la Loi, 1040 Brussels, Belgium |
| Attention: | Mr. Thomas De Smet, Head of Procurement |
| Delivery Contact: | +32 2 555 0147 (Mon–Fri, 08:00–17:00 CET) |
This Purchase Order is issued by Brussels Optical & Vision Centre BV to procure specialised optical equipment, diagnostic instruments, and consumable materials required for the daily operations of our in-house Optometrist team. All items listed below are to be delivered to our Brussels facility in accordance with Belgian regulatory standards for medical and optical devices.
| Item No. | Description | Qty | Unit Price (EUR) | Total (EUR) |
|---|---|---|---|---|
| 001 | Autorefraction & Keratometry System (Topcon KR-7100) – for Optometrist use in patient refraction assessments | 2 | 4,850.00 | 9,700.00 |
| 002 | Phoropter Unit with Full Trial Lens Set – standard Optometrist diagnostic equipment | 3 | 2,340.00 | 7,020.00 |
| 003 | Non-Mydriatic Fundus Camera (Heine Beta 200) – for retinal imaging by the Optometrist | 1 | 6,200.00 | 6,200.00 |
| 004 | Binocular Indirect Ophthalmoscope with 200D Lens – Optometrist examination tool | 4 | 1,150.00 | 4,600.00 |
| 005 | Single-Use Contact Lens Trial Kits (various powers, 100 pairs per box) | 10 | 320.00 | 3,200.00 |
| 006 | Optical Lenses – CR-39 1.50 Index, Single Vision, Assorted Powers (per 50-pack) | 8 | 480.00 | 3,840.00 |
| 007 | Progressive Multifocal Lenses – 1.67 High Index, for Optometrist dispensing | 5 | 1,250.00 | 6,250.00 |
| 008 | Optical Frames – Titanium & Acetate Collection (assorted styles, 20 units) | 1 | 3,400.00 | 3,400.00 |
| 009 | Visual Acuity Chart Projector System – for Optometrist patient testing | 2 | 890.00 | 1,780.00 |
| 010 | Annual Calibration & Maintenance Service for all Optometrist diagnostic equipment | 1 | 2,100.00 | 2,100.00 |
| Subtotal: | 48,090.00 | |||
| VAT (21% – Belgium Standard Rate): | 10,098.90 | |||
| Grand Total (EUR): | 58,188.90 | |||
- 4.1 This Purchase Order is governed by the laws of the Kingdom of Belgium. Any disputes arising from this Purchase Order shall be subject to the exclusive jurisdiction of the Commercial Court of Brussels, Belgium Brussels.
- 4.2 All equipment and materials supplied under this Purchase Order must comply with the European Union Medical Devices Regulation (EU) 2017/745 and applicable Belgian optical industry standards as enforced by the Federal Agency for Medicines and Health Products (FAMHP).
- 4.3 The Optometrist team at Brussels Optical & Vision Centre BV shall be responsible for the final inspection and acceptance of all delivered items. Acceptance shall be confirmed in writing within five (5) business days of delivery.
- 4.4 Payment shall be made via bank transfer to the supplier's designated Belgian bank account within thirty (30) calendar days from the date of invoice receipt. Late payments shall incur interest at the rate prescribed by the Belgian Law of 2 August 2002 on late payment in commercial transactions.
- 4.5 The supplier warrants that all diagnostic instruments and optical products listed in this Purchase Order are new, unused, and free from defects. A minimum warranty period of twenty-four (24) months applies to all capital equipment.
- 4.6 Delivery shall be made DDP (Delivered Duty Paid) to the receiving address in Belgium Brussels. All shipping, insurance, and customs clearance costs (if applicable for intra-EU transfers) are included in the unit prices stated above.
- 4.7 The supplier must provide full technical documentation, user manuals in both Dutch and French, and any required CE marking certificates for all equipment delivered under this Purchase Order.
- 4.8 This Purchase Order may be amended only by mutual written agreement between both parties. No verbal modifications shall be binding.
- 4.9 The supplier agrees to maintain confidentiality regarding all patient data and operational information of the Optometrist practice in Belgium Brussels in accordance with the GDPR (EU) 2016/679 and the Belgian Data Protection Act of 30 July 2018.
All items referenced in this Purchase Order must be delivered to the Brussels Optical & Vision Centre BV premises located at 124 Rue de la Loi, 1040 Brussels, Belgium. The supplier is required to coordinate delivery with our on-site Optometrist, Dr. Annelise Vermeulen, to ensure proper installation, calibration, and initial operational testing of all diagnostic equipment. Installation services are included in the unit pricing for items 001, 002, 003, and 009. The supplier shall provide a written installation report signed by both the supplier's technician and our Lead Optometrist upon completion.
This Purchase Order is authorised and approved by the undersigned representatives of Brussels Optical & Vision Centre BV. By signing below, both parties acknowledge and agree to all terms, conditions, and specifications outlined in this document pertaining to the procurement of Optometrist equipment and services in Belgium Brussels.
For Brussels Optical & Vision Centre BV (Buyer):
Thomas De SmetHead of Procurement
Date: _______________
For OptiVision Belgium SRL (Supplier):
Dr. Annelise VermeulenLead Optometrist & Account Manager
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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