Purchase Order Orthodontist in Israel Tel Aviv –Free Word Template Download with AI
MediDent Procurement Division
45 Allenby Street, Tel Aviv-Yafo, Israel 6610100
Tel: +972-3-621-4400 | Email: [email protected]
VAT No. 51-234-567-8 | Registration No. 51-234567-8
SUPPLIER / VENDOR INFORMATION| Company Name: Dr. Miriam Levi Orthodontic Center | VAT No.: 51-876-543-2 |
| Address: 12 Herzl Street, Tel Aviv-Yafo, Israel 6500100 | Contact Person: Dr. Miriam Levi, Lead Orthodontist |
| Phone: +972-3-512-7788 | Email: [email protected] |
| License No.: IL-ORTHO-2019-00342 (Issued by the Israeli Ministry of Health, Tel Aviv Regional Authority) | |
| MediDent Procurement Division 45 Allenby Street, Floor 3 Tel Aviv-Yafo, Israel 6610100 Attn: Mr. David Cohen, Procurement Manager Tel: +972-3-621-4400 |
Delivery Instructions: Deliver all orthodontic materials and equipment to the Tel Aviv central warehouse. A receiving clerk will be available between 08:00 and 16:00, Monday through Friday. All items must be accompanied by the original packing slip referencing this Purchase Order number. |
| # | Description | Qty | Unit Price (ILS) | Total (ILS) | Remarks |
|---|---|---|---|---|---|
| 1 | Self-ligating orthodontic brackets, ceramic, upper and lower arch (per set) | 120 sets | ₪ 1,850.00 | ₪ 222,000.00 | For use by the Orthodontist team at the Tel Aviv clinic |
| 2 | NiTi archwires, 0.014" to 0.022" (full range, per pack of 50) | 200 packs | ₪ 320.00 | ₪ 64,000.00 | Must meet Israeli medical device regulations |
| 3 | Clear aligner trays, custom-molded (per patient set, 20 trays) | 85 sets | ₪ 4,200.00 | ₪ 357,000.00 | Custom fabrication by the Orthodontist's lab in Tel Aviv |
| 4 | Orthodontic elastics, assorted sizes and colors (per box of 1,000) | 60 boxes | ₪ 185.00 | ₪ 11,100.00 | — |
| 5 | Professional orthodontic consultation and treatment planning session (per patient) | 40 sessions | ₪ 1,500.00 | ₪ 60,000.00 | Conducted by the supervising Orthodontist in Tel Aviv |
| 6 | CBCT imaging and digital scan for orthodontic treatment (per patient) | 40 scans | ₪ 950.00 | ₪ 38,000.00 | Performed at the Tel Aviv imaging center |
| 7 | Orthodontic bonding agent and composite resin (per kit) | 150 kits | ₪ 210.00 | ₪ 31,500.00 | — |
| 8 | Annual maintenance and calibration of orthodontic equipment (per unit) | 12 units | ₪ 2,800.00 | ₪ 33,600.00 | Service to be performed in Tel Aviv premises |
| Subtotal: | ₪ 817,200.00 | ||||
| VAT (18%): | ₪ 147,096.00 | ||||
| GRAND TOTAL (ILS): | ₪ 964,296.00 | ||||
1. This Purchase Order is issued by MediDent Procurement Division, Tel Aviv, Israel, and constitutes a binding agreement upon acceptance by the supplier. All orthodontic products and services referenced herein must comply with the regulations set forth by the Israeli Ministry of Health and the Israel Standards Institute (SII).
2. The Orthodontist and all associated clinical staff at Dr. Miriam Levi Orthodontic Center, Tel Aviv, shall maintain valid professional licenses and malpractice insurance throughout the duration of this Purchase Order. Any lapse in licensure will constitute grounds for immediate termination.
3. All orthodontic materials must be CE-marked or approved by the Israeli Ministry of Health for medical use in Israel. The supplier shall provide certificates of conformity and batch traceability documentation with each delivery to the Tel Aviv warehouse.
4. Delivery of all physical goods shall be made to the address specified in the Delivery Address section of this Purchase Order. The supplier bears all risk of loss or damage until the goods are received and signed for by the designated receiving clerk in Tel Aviv.
5. Payment shall be made within thirty (30) calendar days of the date of the valid invoice, provided that all goods and services have been received and inspected in Tel Aviv without deficiency. Payment will be made via bank transfer to the supplier's Israeli bank account.
6. The Orthodontist shall provide a written treatment plan and progress report for each patient covered under this Purchase Order within five (5) business days of each clinical session conducted in Tel Aviv. Reports must be submitted in both Hebrew and English.
7. Any changes to the scope, quantity, or specifications of items listed in this Purchase Order must be approved in writing by the Procurement Manager, Mr. David Cohen, before execution. Verbal modifications are not valid.
8. This Purchase Order is governed by the laws of the State of Israel. Any disputes arising from this document shall be subject to the exclusive jurisdiction of the competent courts in Tel Aviv, Israel.
9. The supplier warrants that all orthodontic equipment and materials are new, unused, and free from defects. A minimum warranty period of twenty-four (24) months applies to all capital equipment delivered under this Purchase Order.
10. This Purchase Order is valid for acceptance within fourteen (14) calendar days from the date of issue. Failure to confirm acceptance within this period will result in automatic cancellation of the order.
AUTHORIZATION AND SIGNATURESPrepared by (Buyer):
MediDent Procurement Division, Tel Aviv, Israel
Name: David CohenTitle: Procurement Manager
Signature: _________________________
Date: 14 June 2025
Accepted by (Supplier / Orthodontist):
Dr. Miriam Levi Orthodontic Center, Tel Aviv, Israel
Name: Dr. Miriam LeviTitle: Lead Orthodontist / Practice Owner
Signature: _________________________
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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