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Purchase Order Optometrist in Canada Montreal –Free Word Template Download with AI

Clinique Optométrique du Centre-Ville

4520 Boulevard Saint-Laurent, Suite 310, Canada Montreal, QC H2T 1N4

Telephone: (514) 555-0187  |  Email: [email protected]

QST Registration No.: 123456789QST0001

Purchase Order No.: PO-2025-04872

Date of Issue: June 12, 2025

Required Delivery Date: July 15, 2025

Payment Terms: Net 30 Days

Incoterms: DDP – Canada Montreal

Currency: Canadian Dollars (CAD)

Prepared By: Marie-Claude Tremblay, Procurement Manager

Approved By: Dr. Antoine Lavoie, Lead Optometrist

Status: APPROVED

Company Name: OptiSource Canada Inc.
Address: 8800 Rue de l'Église, Brossard, QC J4Z 2P5, Canada
Contact Person: David Chen, Regional Sales Director
Phone / Email: (450) 555-0342 / [email protected]
Business Number (BN): 789123456RT0001
Item # Description Qty Unit Price (CAD) Subtotal (CAD)
001 Topcon Autorefractor AR-1100 – Digital autorefractor for comprehensive optometrist eye examinations, including keratometry and pupillometry modules 2 $18,450.00 $36,900.00
002 Nidek OPK-1000K Plus – Objective Pentacam for corneal topography, essential for the optometrist to diagnose astigmatism and keratoconus 1 $24,780.00 $24,780.00
003 Zeiss I-PROBE 100 – Infrared retinal imaging system for the optometrist to perform non-invasive fundus photography and diabetic retinopathy screening 1 $32,150.00 $32,150.00
004 Essilor Varilux X Series – Progressive addition lenses (12 pairs, mixed prescriptions) for patient dispensing by the optometrist 12 $485.00 $5,820.00
005 Ray-Ban Aviator & Wayfarer Frames – Assorted styles for the optometrist's dispensing inventory (20 units) 20 $125.00 $2,500.00
006 Heine Omega 200 – Binocular indirect ophthalmoscope for the optometrist to perform dilated eye examinations 3 $1,890.00 $5,670.00
007 Penlight & Slit Lamp Accessories Kit – Complete accessory bundle for the optometrist's daily clinical workflow 5 $340.00 $1,700.00
008 Eye Chart – Snellen & LogMAR Combination Wall Charts (Canadian French/English bilingual), for the optometrist's examination rooms 4 $185.00 $740.00
009 Disposable Contact Lens Trial Kits – Soft and RGP trial lenses for the optometrist to fit and prescribe contact lenses 50 $28.50 $1,425.00
010 Annual Calibration & Maintenance Service – For all diagnostic equipment listed above, performed by certified technicians in Canada Montreal 1 $4,200.00 $4,200.00

Subtotal: $116,685.00 CAD

Quebec Sales Tax (QST) 9.975%: $11,639.33 CAD

Freight & Delivery to Canada Montreal: $1,250.00 CAD

Grand Total: $129,574.33 CAD

  1. This Purchase Order is issued by Clinique Optométrique du Centre-Ville, a licensed optometrist practice operating in Canada Montreal, in accordance with the Quebec College of Optometrists (Ordre des optométristes du Québec) regulatory standards.
  2. All equipment and supplies listed herein must comply with Health Canada regulations and the Canadian Medical Device Regulations (CMDR). The vendor shall provide all applicable Medical Device Licenses and certificates of conformity prior to delivery.
  3. Delivery shall be made to the optometrist's clinic at 4520 Boulevard Saint-Laurent, Canada Montreal, QC H2T 1N4. The vendor is responsible for all shipping, handling, and insurance costs until the goods are received and inspected at the designated Canada Montreal location.
  4. Payment shall be made within thirty (30) calendar days of the invoice date, by electronic funds transfer (EFT) to the vendor's designated Canadian bank account. Late payments shall accrue interest at the rate of 1.5% per month as stipulated under the Quebec Civil Code.
  5. The optometrist reserves the right to inspect all delivered items within five (5) business days of receipt. Any defective, damaged, or non-conforming goods must be reported in writing to the vendor, who shall replace or credit the affected items within ten (10) business days at no additional cost.
  6. All diagnostic equipment must be installed, calibrated, and certified by the vendor's authorized service technicians at the Canada Montreal clinic prior to the Required Delivery Date. The optometrist shall not be liable for any operational use of equipment until a written Certificate of Calibration is provided.
  7. This Purchase Order is governed by the laws of the Province of Quebec and the federal laws of Canada applicable therein. Any disputes arising from this Purchase Order shall be subject to the exclusive jurisdiction of the courts of Canada Montreal, Quebec.
  8. The vendor warrants that all products are new, unused, and free from defects in materials and workmanship for a period of no less than twenty-four (24) months from the date of delivery. This warranty is in addition to, and does not replace, any statutory warranties under the Quebec Consumer Protection Act.
  9. Neither party may assign this Purchase Order or any rights or obligations hereunder without the prior written consent of the other party. This Purchase Order constitutes the entire agreement between the parties with respect to the subject matter herein.
  10. All communications regarding this Purchase Order shall be directed to the procurement office of the optometrist's practice in Canada Montreal. Verbal modifications to this Purchase Order shall be null and void unless confirmed in writing by both parties.

For and on behalf of the Purchaser (Optometrist Practice):

Dr. Antoine Lavoie, O.O.
Lead Optometrist & Practice Owner
Clinique Optométrique du Centre-Ville
Canada Montreal, QC
Date: ______________________

For and on behalf of the Vendor:

David Chen
Regional Sales Director
OptiSource Canada Inc.
Brossard, QC
Date: ______________________

This Purchase Order (PO-2025-04872) was generated for the optometrist practice of Clinique Optométrique du Centre-Ville, Canada Montreal. All transactions are subject to the regulatory oversight of the Ordre des optométristes du Québec and Health Canada. Document reference: PO-2025-04872 | Version 1.0 | June 12, 2025.

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