Purchase Order Optometrist in United States Houston –Free Word Template Download with AI
ClearView Optometry Associates, PLLC
4820 Westheimer Road, Suite 310, Houston, Texas 77056, United States
Phone: (713) 555-0142 | Fax: (713) 555-0143 | Email: [email protected]
Texas Board of Optometry License No. TX-OP-2019-4471 | EIN: 74-2839105
| Item # | Description | Qty | Unit Price (USD) | Extended Price (USD) |
|---|---|---|---|---|
| 1 | Topcon Autorefractor / Keratometer ARK-530A – Diagnostic equipment for the Optometrist to perform comprehensive refraction examinations at the Houston clinic | 1 | $12,450.00 | $12,450.00 |
| 2 | Zeiss I-PROBE Plus Corneal Topography System – Advanced imaging device required by the Optometrist for corneal mapping and contact lens fitting | 1 | $18,900.00 | $18,900.00 |
| 3 | Heine Omega 200 Direct Ophthalmoscope (Set of 4) – Essential examination instruments for the Optometrist to conduct dilated fundus examinations | 4 | $1,275.00 | $5,100.00 |
| 4 | Penlights, 3-LED, 100,000 Lux (Pack of 20) – General examination lighting for the Optometrist and assisting staff | 2 | $89.00 | $178.00 |
| 5 | Phoropter, Nidek NP-200 – Primary refraction instrument used by the Optometrist during patient eye examinations | 1 | $4,850.00 | $4,850.00 |
| 6 | Non-Mydriatic Fundus Camera, Kowa FX-50 – Retinal imaging system for the Optometrist to document and monitor retinal pathology | 1 | $9,200.00 | $9,200.00 |
| 7 | Disposable Trial Lens Frames and Lens Set (Complete) – Consumable supplies for the Optometrist during subjective refraction | 3 | $320.00 | $960.00 |
| 8 | Visual Acuity Charts, Snellen and LogMAR (Wall-Mounted, Set of 6) – Standard testing materials for the Optometrist's examination rooms | 2 | $145.00 | $290.00 |
| 9 | Slit Lamp Biomicroscope, Topcon SL-18D – Primary diagnostic instrument for the Optometrist to examine anterior segment structures | 1 | $7,600.00 | $7,600.00 |
| 10 | Mydriatic Eye Drops, Tropicamide 1% (Bottles of 30mL, Case of 12) – Pharmacological agents prescribed by the Optometrist for pupil dilation during examinations | 4 | $185.00 | $740.00 |
| Subtotal: | $60,268.00 |
| Texas Sales Tax (8.25% – Harris County, Houston): | $4,972.11 |
| Freight and Installation (Houston, United States): | $1,150.00 |
| Grand Total (USD): | $66,390.11 |
- This Purchase Order is issued by ClearView Optometry Associates, PLLC, a licensed Optometrist practice operating in Houston, United States, and is governed by the commercial laws of the State of Texas and applicable federal regulations.
- All items listed in this Purchase Order are intended for use by the Optometrist and clinical staff at the Houston, Texas clinic located at 4820 Westheimer Road. The vendor acknowledges that the equipment must comply with all standards set forth by the Texas Board of Optometry and the American Optometric Association.
- Payment terms: Net 45 days from the date of confirmed delivery and acceptance of goods at the Houston, United States facility. Payment shall be made via ACH transfer to the vendor's designated account.
- Delivery must be made to the specified address in Houston, United States, between 8:00 AM and 4:00 PM Central Time, Monday through Friday. The vendor is responsible for all shipping, handling, and on-site installation of capital equipment items (Items 1, 2, 5, 6, and 9).
- All capital equipment must include a minimum two-year manufacturer's warranty covering parts and labor. The Optometrist reserves the right to reject any item that does not meet the specifications outlined in this Purchase Order or that arrives damaged.
- The vendor shall provide all necessary documentation, including certificates of compliance, FDA registration numbers where applicable, and calibration certificates, to ensure the Optometrist can maintain full regulatory compliance with the Texas Board of Optometry and the United States Food and Drug Administration.
- Any changes to this Purchase Order must be made in writing and signed by both parties. Verbal modifications are not binding. The Optometrist reserves the right to cancel or modify line items up to fourteen (14) days prior to the required delivery date without penalty.
- Force Majeure: Neither party shall be liable for delays caused by events beyond reasonable control, including but not limited to natural disasters affecting the Houston, United States metropolitan area, supply chain disruptions, or government-mandated closures.
- This Purchase Order constitutes the entire agreement between the parties regarding the purchase of the described goods and supersedes all prior negotiations, representations, or agreements, whether written or oral.
- Disputes arising from this Purchase Order shall be resolved through binding arbitration in Harris County, Houston, Texas, United States, in accordance with the rules of the American Arbitration Association.
Authorized by (Buyer):
Dr. Sarah Mitchell, O.D.Lead Optometrist, ClearView Optometry Associates, PLLC
Date: ______________________
Accepted by (Vendor):
Daniel ReevesRegional Sales Manager, Precision Optical Supply Co., Inc.
Date: ______________________ ⬇️ Download as DOCX Edit online as DOCX
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